Provider Demographics
NPI:1619338662
Name:VALLI, LAUREL (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:
Last Name:VALLI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12284 W KEN CARYL CIR APT 307
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3144
Mailing Address - Country:US
Mailing Address - Phone:203-988-8426
Mailing Address - Fax:
Practice Address - Street 1:5912 S CODY ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-9542
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist