Provider Demographics
NPI:1841500295
Name:JACOBSEN, CHRISTINE LYNN (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19731 E PIKES PEAK CT
Mailing Address - Street 2:STE 201
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7401
Mailing Address - Country:US
Mailing Address - Phone:303-913-8686
Mailing Address - Fax:
Practice Address - Street 1:19731 E PIKES PEAK CT
Practice Address - Street 2:STE 201
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7401
Practice Address - Country:US
Practice Address - Phone:303-913-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-11066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist