Provider Demographics
NPI:1275203937
Name:BROW, KATINA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:MARIE
Last Name:BROW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATINA
Other - Middle Name:M
Other - Last Name:BOHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 29TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6319
Mailing Address - Country:US
Mailing Address - Phone:970-342-5815
Mailing Address - Fax:
Practice Address - Street 1:1011 37TH AVENUE CT UNIT 101A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2553
Practice Address - Country:US
Practice Address - Phone:970-614-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist