Provider Demographics
NPI:1982136404
Name:AGAKIAN COLON, STEPHANIE KAY (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:AGAKIAN COLON
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 1:9769 W 119TH DR STE 28
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-2560
Mailing Address - Country:US
Mailing Address - Phone:720-295-0896
Mailing Address - Fax:
Practice Address - Street 1:9769 W 119TH DR
Practice Address - Street 2:STE 23
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-2586
Practice Address - Country:US
Practice Address - Phone:720-295-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014712173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist