Provider Demographics
NPI:1790949436
Name:LAINE, COLLEEN MARGARET (CMT CNMT MAT SPECIAL)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARGARET
Last Name:LAINE
Suffix:
Gender:F
Credentials:CMT CNMT MAT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4025
Mailing Address - Country:US
Mailing Address - Phone:303-477-3025
Mailing Address - Fax:303-762-8822
Practice Address - Street 1:3501 S CORONA ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3907
Practice Address - Country:US
Practice Address - Phone:303-320-4367
Practice Address - Fax:303-762-8822
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist