Provider Demographics
NPI:1518396142
Name:DESROSIERS, MYRIAM (CMT, RMT)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:CMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 MATHEWS CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7267
Mailing Address - Country:US
Mailing Address - Phone:303-960-8616
Mailing Address - Fax:
Practice Address - Street 1:618 MATHEWS CIR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7267
Practice Address - Country:US
Practice Address - Phone:303-960-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty