Provider Demographics
NPI:1467234724
Name:MUNOZ, JANELLE KRISTA (MT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:KRISTA
Last Name:MUNOZ
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 1:505 SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1322
Mailing Address - Country:US
Mailing Address - Phone:719-299-8888
Mailing Address - Fax:
Practice Address - Street 1:3920 N UNION BLVD STE 160
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4907
Practice Address - Country:US
Practice Address - Phone:719-471-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0026077225700000X
COMT.0026077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist