Provider Demographics
NPI:1497048771
Name:WINDHORN, CORY JACOB (LMT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:JACOB
Last Name:WINDHORN
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 1:8955 RIDGELINE BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2362
Mailing Address - Country:US
Mailing Address - Phone:720-488-4100
Mailing Address - Fax:
Practice Address - Street 1:8955 RIDGELINE BLVD
Practice Address - Street 2:STE 500
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80129-2362
Practice Address - Country:US
Practice Address - Phone:720-488-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist