Provider Demographics
NPI:1639738172
Name:FORD, RENEE M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:PAULSMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:4202 MONROE DR APT A
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2187
Mailing Address - Country:US
Mailing Address - Phone:303-647-1576
Mailing Address - Fax:
Practice Address - Street 1:4202 MONROE DR APT A
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2187
Practice Address - Country:US
Practice Address - Phone:303-647-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT319050-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist