Provider Demographics
NPI:1740899681
Name:ZHAO, HUSHAN (MT)
Entity type:Individual
Prefix:
First Name:HUSHAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8097
Mailing Address - Country:US
Mailing Address - Phone:303-335-5343
Mailing Address - Fax:
Practice Address - Street 1:1610 LEE HILL RD UNIT 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0882
Practice Address - Country:US
Practice Address - Phone:303-335-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist