Provider Demographics
NPI:1962857458
Name:LAURITA, ANGELA (CMT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:LAURITA
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 1:2825 MARINE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1027
Mailing Address - Country:US
Mailing Address - Phone:720-308-2096
Mailing Address - Fax:
Practice Address - Street 1:2825 MARINE ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1027
Practice Address - Country:US
Practice Address - Phone:720-308-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist