Provider Demographics
NPI:1841010055
Name:RENTZ, MATTHEW JACOB (LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JACOB
Last Name:RENTZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6174 TREVARTON DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9028
Mailing Address - Country:US
Mailing Address - Phone:845-558-0738
Mailing Address - Fax:
Practice Address - Street 1:3970 BROADWAY ST UNIT 201G
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1135
Practice Address - Country:US
Practice Address - Phone:845-558-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026869225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist