Provider Demographics
NPI:1750799573
Name:NINIS, JULIE (NCBTMB)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:NINIS
Suffix:
Gender:F
Credentials:NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FLORIDA RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6836
Mailing Address - Country:US
Mailing Address - Phone:970-259-2579
Mailing Address - Fax:
Practice Address - Street 1:1600 FLORIDA RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6836
Practice Address - Country:US
Practice Address - Phone:970-259-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist