Provider Demographics
NPI:1902201270
Name:RAGSDALE, AMY (RMT, CNMT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:RMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 COYOTE WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7610
Mailing Address - Country:US
Mailing Address - Phone:719-277-0309
Mailing Address - Fax:
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1022
Practice Address - Country:US
Practice Address - Phone:719-237-5623
Practice Address - Fax:719-528-5388
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0012383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist