Provider Demographics
NPI:1164703617
Name:POSCH, THEA (CMT, CCST)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:POSCH
Suffix:
Gender:F
Credentials:CMT, CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 NEBRINA PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1517
Mailing Address - Country:US
Mailing Address - Phone:720-289-2590
Mailing Address - Fax:
Practice Address - Street 1:2874 NEBRINA PL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1517
Practice Address - Country:US
Practice Address - Phone:720-289-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist