Provider Demographics
NPI:1245509850
Name:CHRITINAS ROAD TO SUCCESS
Entity type:Organization
Organization Name:CHRITINAS ROAD TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRITINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-400-8975
Mailing Address - Street 1:21402 E CRESTRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3593
Mailing Address - Country:US
Mailing Address - Phone:303-400-8975
Mailing Address - Fax:303-400-8975
Practice Address - Street 1:21402 E CRESTRIDGE PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3593
Practice Address - Country:US
Practice Address - Phone:303-400-8975
Practice Address - Fax:303-400-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty