Provider Demographics
NPI:1891338455
Name:SCHIRADO, MITZI (LMT)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:SCHIRADO
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 1:440 COUNTY ROAD 4051
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-8716
Mailing Address - Country:US
Mailing Address - Phone:970-531-8020
Mailing Address - Fax:
Practice Address - Street 1:62543 US HWY 40
Practice Address - Street 2:UNIT H
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-8044
Practice Address - Country:US
Practice Address - Phone:970-531-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist