Provider Demographics
NPI:1164070306
Name:LABOUNTA, KRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LABOUNTA
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:PO BOX 1643
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-1643
Mailing Address - Country:US
Mailing Address - Phone:719-239-1728
Mailing Address - Fax:
Practice Address - Street 1:914 YALE AVE
Practice Address - Street 2:BUENA VISTA
Practice Address - City:CO
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-239-1728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist