Provider Demographics
NPI:1982871380
Name:EATON THERAPEUTIC CENTER
Entity Type:Organization
Organization Name:EATON THERAPEUTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ARLEEN
Authorized Official - Last Name:MONGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:970-454-2224
Mailing Address - Street 1:123 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-3425
Mailing Address - Country:US
Mailing Address - Phone:970-454-2224
Mailing Address - Fax:970-454-3147
Practice Address - Street 1:123 ELM AVE
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-3425
Practice Address - Country:US
Practice Address - Phone:970-454-2224
Practice Address - Fax:970-454-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14277290000251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare