Provider Demographics
NPI:1821229881
Name:INDIGO LOTUS, INC
Entity Type:Organization
Organization Name:INDIGO LOTUS, INC
Other - Org Name:DIFFERENT STROKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DHARMALYNNE
Authorized Official - Middle Name:DEBEAUX
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:970-207-9700
Mailing Address - Street 1:3307 S COLLEGE AVE
Mailing Address - Street 2:#102B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4196
Mailing Address - Country:US
Mailing Address - Phone:970-207-9700
Mailing Address - Fax:
Practice Address - Street 1:3307 S COLLEGE AVE
Practice Address - Street 2:#102B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4196
Practice Address - Country:US
Practice Address - Phone:970-207-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty