Provider Demographics
NPI:1982285557
Name:MUNTZERT, KYLIE ECHO (LMT, CNMT, TYMP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ECHO
Last Name:MUNTZERT
Suffix:
Gender:F
Credentials:LMT, CNMT, TYMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2309
Mailing Address - Country:US
Mailing Address - Phone:719-339-1386
Mailing Address - Fax:
Practice Address - Street 1:205 S RACE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2309
Practice Address - Country:US
Practice Address - Phone:719-339-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist