Provider Demographics
NPI:1790014140
Name:GREINER, MARVIN R (RMT)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:R
Last Name:GREINER
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 W 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2920
Mailing Address - Country:US
Mailing Address - Phone:303-877-1735
Mailing Address - Fax:303-940-8330
Practice Address - Street 1:8725 WADSWORTH BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0928
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:303-940-8330
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1437212925OtherSTANDLEY LAKE MASSAGE THERAPY, INC.