Provider Demographics
NPI:1619720380
Name:STOLTZ, CHESLEY (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:CHESLEY
Middle Name:
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 RAMSGATE TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3118
Mailing Address - Country:US
Mailing Address - Phone:214-912-6296
Mailing Address - Fax:
Practice Address - Street 1:915 PINON RANCH VW STE 3
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3578
Practice Address - Country:US
Practice Address - Phone:214-912-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist