Provider Demographics
NPI:1497078331
Name:BASHKIN, MARY H (CMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:BASHKIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2261
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2261
Mailing Address - Country:US
Mailing Address - Phone:970-391-7491
Mailing Address - Fax:
Practice Address - Street 1:315 CANYON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2677
Practice Address - Country:US
Practice Address - Phone:970-391-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist