Provider Demographics
NPI:1477179067
Name:GALVN, LUIS HUMBERTO (LMT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:HUMBERTO
Last Name:GALVN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4288 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2436
Mailing Address - Country:US
Mailing Address - Phone:303-274-4434
Mailing Address - Fax:303-274-4441
Practice Address - Street 1:4288 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2436
Practice Address - Country:US
Practice Address - Phone:303-274-4434
Practice Address - Fax:303-274-4441
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty