Provider Demographics
NPI:1134891898
Name:DEL TORO, MARIA KATHLEEN (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KATHLEEN
Last Name:DEL TORO
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 1:1050 S DAHLIA ST APT C32
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2823
Mailing Address - Country:US
Mailing Address - Phone:414-232-6936
Mailing Address - Fax:
Practice Address - Street 1:4340 E KENTUCKY AVE STE 241
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2070
Practice Address - Country:US
Practice Address - Phone:414-232-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0019418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist