Individual
MR. SAMUEL WAYNE MOULDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
612 W LAUREL ST, FORT COLLINS, CO 80521-3620
(701) 740-0551
Mailing address
317 E LAUREL ST, FORT COLLINS, CO 80524-3155
(701) 740-0551
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0023620
CO
Other
Enumeration date
03/11/2022
Last updated
03/11/2022
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