Provider Demographics
NPI:1760079602
Name:DAME, SAMANTHA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:DAME
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9227 W ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5112
Mailing Address - Country:US
Mailing Address - Phone:303-988-3311
Mailing Address - Fax:
Practice Address - Street 1:9227 W ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5112
Practice Address - Country:US
Practice Address - Phone:303-667-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0004095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist