Provider Demographics
NPI:1821769787
Name:NYMAN, ALEXANDRA MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:NYMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 BALLESTEROS CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8876
Mailing Address - Country:US
Mailing Address - Phone:503-442-4417
Mailing Address - Fax:
Practice Address - Street 1:2601 MIDPOINT DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4448
Practice Address - Country:US
Practice Address - Phone:503-442-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist