Individual
CARLA YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMT
Contact information
Practice address
151 E. BENNETT AVE., CRIPPLE CREEK, CO 80813
(719) 689-3502
Mailing address
PO BOX 555, VICTOR, CO 80860-0555
(719) 689-3502
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11831
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#MT11831
STATE
CO
Enumeration date
12/19/2012
Last updated
12/19/2012
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