Provider Demographics
NPI:1922339985
Name:HARRIS-ISRANGKURA, DINA (RMT)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:HARRIS-ISRANGKURA
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 SCHOOLED ROAD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-3005
Mailing Address - Country:US
Mailing Address - Phone:720-309-2600
Mailing Address - Fax:
Practice Address - Street 1:141 SCHOOLED ROAD
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-3005
Practice Address - Country:US
Practice Address - Phone:720-309-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist