Individual
MR. JACK VANAUSDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
3880 GRANT AVE STE 140, LOVELAND, CO 80538-8433
(970) 215-2380
Mailing address
3880 GRANT AVE STE 140, LOVELAND, CO 80538-8433
(970) 215-2380
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
02/07/2007
Last updated
04/14/2020
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