Provider Demographics
NPI:1407219926
Name:SONG, JING (MT)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9688 AUTUMNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5772
Mailing Address - Country:US
Mailing Address - Phone:303-471-0888
Mailing Address - Fax:
Practice Address - Street 1:537 W HIGHLANDS RANCH PKWY STE 112
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-6951
Practice Address - Country:US
Practice Address - Phone:303-471-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist