Individual
LASEA WILKINS-BRANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2615 SHOOTING STAR WAY, EVANS, CO 80620-9244
(970) 599-2395
Mailing address
2615 SHOOTING STAR WAY, EVANS, CO 80620-9244
(970) 599-2395
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0017698
CO
Other
Enumeration date
01/12/2017
Last updated
04/27/2017
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