Provider Demographics
NPI:1477156594
Name:BANGERT, HALEY IRIS (LMT)
Entity Type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:IRIS
Last Name:BANGERT
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 1:200 IDALIA CT APT 203
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9022
Mailing Address - Country:US
Mailing Address - Phone:303-241-4726
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE 420
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2575
Practice Address - Country:US
Practice Address - Phone:303-241-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist