Provider Demographics
NPI:1629679378
Name:SCHUCK, AMY (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SCHUCK
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 1:18275 COUNTY ROAD 501
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8715
Mailing Address - Country:US
Mailing Address - Phone:303-478-1445
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST STE 200
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7308
Practice Address - Country:US
Practice Address - Phone:970-375-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist