Provider Demographics
NPI:1801175526
Name:WILLIAMS, ROSE MARIE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 S XENOPHON WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-1776
Mailing Address - Country:US
Mailing Address - Phone:720-205-1144
Mailing Address - Fax:
Practice Address - Street 1:30940 STAGECOACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7984
Practice Address - Country:US
Practice Address - Phone:303-674-1594
Practice Address - Fax:303-674-9870
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-7397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist