Provider Demographics
NPI:1912309063
Name:GWYTHER, JULIA (LAC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GWYTHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 14TH ST UNIT A-2
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5177
Mailing Address - Country:US
Mailing Address - Phone:970-247-8838
Mailing Address - Fax:970-247-8838
Practice Address - Street 1:128 W 14TH ST UNIT A-2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5177
Practice Address - Country:US
Practice Address - Phone:970-247-8838
Practice Address - Fax:970-247-8838
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist