Provider Demographics
NPI:1700284239
Name:HILLE, MARCUS (BA, LMT, NCBTMB, ART)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:HILLE
Suffix:
Gender:M
Credentials:BA, LMT, NCBTMB, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3219
Mailing Address - Country:US
Mailing Address - Phone:970-946-9908
Mailing Address - Fax:
Practice Address - Street 1:667 NORTH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3219
Practice Address - Country:US
Practice Address - Phone:970-946-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0011050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist