Provider Demographics
NPI:1457571788
Name:CHRISTODARO, DIANE MARIE (CMT LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:CHRISTODARO
Suffix:
Gender:F
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150701
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-0701
Mailing Address - Country:US
Mailing Address - Phone:303-778-9304
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON
Practice Address - Street 2:SUITE 312
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1628
Practice Address - Country:US
Practice Address - Phone:303-778-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist