Provider Demographics
NPI:1548567456
Name:WYNNE, DAWN (CMT, ESTI)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WYNNE
Suffix:
Gender:F
Credentials:CMT, ESTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 MAMMOTH CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-3227
Mailing Address - Country:US
Mailing Address - Phone:970-222-7527
Mailing Address - Fax:
Practice Address - Street 1:3377 MAMMOTH CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-3227
Practice Address - Country:US
Practice Address - Phone:970-222-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist