Provider Demographics
NPI:1982077756
Name:SPROUSE, JANEY (LMT)
Entity Type:Individual
Prefix:
First Name:JANEY
Middle Name:
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JANEY
Other - Middle Name:M
Other - Last Name:PAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6165 LEHMAN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3441
Mailing Address - Country:US
Mailing Address - Phone:719-593-0055
Mailing Address - Fax:844-875-0744
Practice Address - Street 1:6165 LEHMAN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3441
Practice Address - Country:US
Practice Address - Phone:719-593-0055
Practice Address - Fax:844-875-0744
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist