Provider Demographics
NPI:1235999087
Name:SANCHEZ, MAGEDLINE (MT0014200)
Entity Type:Individual
Prefix:
First Name:MAGEDLINE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MT0014200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1821
Mailing Address - Country:US
Mailing Address - Phone:303-548-1084
Mailing Address - Fax:
Practice Address - Street 1:333 DENVER AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1821
Practice Address - Country:US
Practice Address - Phone:303-548-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist