Provider Demographics
NPI:1447582515
Name:HASTINGS, GENEVE MICHAELA (LMT)
Entity Type:Individual
Prefix:MS
First Name:GENEVE
Middle Name:MICHAELA
Last Name:HASTINGS
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 1:311 8TH ST
Mailing Address - Street 2:#400
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3487
Mailing Address - Country:US
Mailing Address - Phone:970-945-1105
Mailing Address - Fax:
Practice Address - Street 1:311 8TH ST
Practice Address - Street 2:#400
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3487
Practice Address - Country:US
Practice Address - Phone:970-945-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-4217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist