Individual
TRACI L BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1810 30TH ST, BOULDER, CO 80301-1035
(413) 531-8774
Mailing address
2300 S ROCK CREEK PKWY APT 29-203, SUPERIOR, CO 80027-4418
(303) 396-5281
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0022032
CO
Other
Enumeration date
09/18/2020
Last updated
09/18/2020
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