Provider Demographics
NPI:1740511658
Name:YOSICK, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:YOSICK
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 1:1930 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-1984
Mailing Address - Country:US
Mailing Address - Phone:602-380-3624
Mailing Address - Fax:
Practice Address - Street 1:1930 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1984
Practice Address - Country:US
Practice Address - Phone:602-380-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist