Provider Demographics
NPI:1144799164
Name:PERESKOKOVA, MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PERESKOKOVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11343 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6824
Mailing Address - Country:US
Mailing Address - Phone:720-891-8192
Mailing Address - Fax:
Practice Address - Street 1:11343 GRAY ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-6824
Practice Address - Country:US
Practice Address - Phone:720-891-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist