Provider Demographics
NPI:1568612059
Name:BAJUSZ, STEPHEN (CMT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BAJUSZ
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:BAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:1700 17TH ST
Mailing Address - Street 2:B-10
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6435
Mailing Address - Country:US
Mailing Address - Phone:917-208-4152
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST
Practice Address - Street 2:SUITE 219
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:917-208-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist