Provider Demographics
NPI:1366039570
Name:FAJARDO, ERIN (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FAJARDO
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 1:8800 RALSTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2249
Mailing Address - Country:US
Mailing Address - Phone:720-253-7940
Mailing Address - Fax:
Practice Address - Street 1:8800 RALSTON RD STE 200
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2249
Practice Address - Country:US
Practice Address - Phone:720-253-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0000649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist