Provider Demographics
NPI:1669758132
Name:MAKSYN, VIDYA (RMT, CNMT)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:MAKSYN
Suffix:
Gender:F
Credentials:RMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10954 CAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6402
Mailing Address - Country:US
Mailing Address - Phone:719-352-6105
Mailing Address - Fax:
Practice Address - Street 1:10954 CAVERHILL DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6402
Practice Address - Country:US
Practice Address - Phone:719-352-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8310225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist