Provider Demographics
NPI:1245075639
Name:PAGE, THERESA LOUISE (RD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:PAGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROCKY MOUNTAIN RA LLC
Mailing Address - Street 2:110 16TH STREET, SUITE 1460
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202
Mailing Address - Country:US
Mailing Address - Phone:303-350-7844
Mailing Address - Fax:
Practice Address - Street 1:605 S CLINTON ST APT 5A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1576
Practice Address - Country:US
Practice Address - Phone:303-350-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered