Provider Demographics
NPI:1770637233
Name:RIEDEL, ROANN LORI (CMT)
Entity Type:Individual
Prefix:MS
First Name:ROANN
Middle Name:LORI
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 E HAMPDEN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224
Mailing Address - Country:US
Mailing Address - Phone:303-758-2638
Mailing Address - Fax:303-758-2633
Practice Address - Street 1:6825 E HAMPDEN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224
Practice Address - Country:US
Practice Address - Phone:303-758-2638
Practice Address - Fax:303-758-2633
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist