Provider Demographics
NPI:1912647918
Name:HASTINGS, THERESA (LMT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HASTINGS
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 1:1042 S QUAIL WAY APT SUITE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3858
Mailing Address - Country:US
Mailing Address - Phone:720-934-4409
Mailing Address - Fax:
Practice Address - Street 1:7475 W 5TH AVE STE 201A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1674
Practice Address - Country:US
Practice Address - Phone:720-934-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0008632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist