Provider Demographics
NPI:1831762335
Name:MAUDLIN, LYNSEY JENELLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:LYNSEY
Middle Name:JENELLE
Last Name:MAUDLIN
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:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-1831
Mailing Address - Country:US
Mailing Address - Phone:720-650-9890
Mailing Address - Fax:
Practice Address - Street 1:1173 STRAIGHT CREEK DR # G103
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-6967
Practice Address - Country:US
Practice Address - Phone:720-650-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116120225700000X
WA60783952225700000X
CO0019033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist