Provider Demographics
NPI:1326526575
Name:KNUTSON, DUSTIN ALLEN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ALLEN
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4819
Mailing Address - Country:US
Mailing Address - Phone:719-360-6724
Mailing Address - Fax:
Practice Address - Street 1:2314 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4819
Practice Address - Country:US
Practice Address - Phone:719-360-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO439875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist