Provider Demographics
NPI:1457507311
Name:ROBERTSON, DESTINE (CMT)
Entity Type:Individual
Prefix:
First Name:DESTINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19574 SILVER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-5607
Mailing Address - Country:US
Mailing Address - Phone:303-810-7069
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE A101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2556
Practice Address - Country:US
Practice Address - Phone:303-850-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist