Provider Demographics
NPI:1790207470
Name:VETANZE, MARIO N (LMT, CPEP)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:N
Last Name:VETANZE
Suffix:
Gender:M
Credentials:LMT, CPEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 S PARKER RD STE 125
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7113
Mailing Address - Country:US
Mailing Address - Phone:303-693-2225
Mailing Address - Fax:
Practice Address - Street 1:4090 S PARKER RD STE 125
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-7113
Practice Address - Country:US
Practice Address - Phone:303-693-2225
Practice Address - Fax:303-693-2225
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist