Provider Demographics
NPI:1952792434
Name:GILLESPIE, ELIZABETH (MT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 SOUTH MARIPOSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5512
Mailing Address - Country:US
Mailing Address - Phone:303-916-4222
Mailing Address - Fax:
Practice Address - Street 1:6972 SOUTH VINE STREET, SUITE 360
Practice Address - Street 2:SOLA SALON SUITES, STUDIO #5
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3269
Practice Address - Country:US
Practice Address - Phone:303-916-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015899174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist