Provider Demographics
NPI:1700041019
Name:MACKELBURGER, RIMA L
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:L
Last Name:MACKELBURGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10789 BRADFORD RD # R
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6403
Mailing Address - Country:US
Mailing Address - Phone:303-904-8641
Mailing Address - Fax:
Practice Address - Street 1:10789 BRADFORD RD # R
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6403
Practice Address - Country:US
Practice Address - Phone:303-904-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCMT072176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCMT072176OtherCERTIFIED MASSAGE THERAPIST