Provider Demographics
NPI:1831490572
Name:SOUL, NYKE (CMT)
Entity Type:Individual
Prefix:
First Name:NYKE
Middle Name:
Last Name:SOUL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 DOWNING ST
Mailing Address - Street 2:101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:350
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3524
Practice Address - Country:US
Practice Address - Phone:303-309-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist