Provider Demographics
NPI:1417292426
Name:PHILIPPON, MARJORY LYNN (CLT, RMT)
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:LYNN
Last Name:PHILIPPON
Suffix:
Gender:F
Credentials:CLT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6002
Mailing Address - Country:US
Mailing Address - Phone:970-769-4653
Mailing Address - Fax:970-247-8911
Practice Address - Street 1:1537 FLORIDA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5792
Practice Address - Country:US
Practice Address - Phone:970-385-6708
Practice Address - Fax:970-247-8911
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist