Provider Demographics
NPI:1467224089
Name:JAMES, EVANGELINE MARGARETTE (MT0018995)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:MARGARETTE
Last Name:JAMES
Suffix:
Gender:F
Credentials:MT0018995
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4016
Mailing Address - Country:US
Mailing Address - Phone:303-467-5337
Mailing Address - Fax:303-467-1131
Practice Address - Street 1:12380 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4016
Practice Address - Country:US
Practice Address - Phone:303-467-5337
Practice Address - Fax:303-467-1131
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018995225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist