Provider Demographics
NPI:1851768345
Name:ANGELICA, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ANGELICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COOK ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5325
Mailing Address - Country:US
Mailing Address - Phone:720-878-7500
Mailing Address - Fax:
Practice Address - Street 1:155 COOK ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5325
Practice Address - Country:US
Practice Address - Phone:720-878-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist