Individual
MR. JACOB CORLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1810 30TH ST STE C, BOULDER, CO 80301-1025
(413) 531-8774
Mailing address
1810 30TH ST STE C, BOULDER, CO 80301-1025
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0016771
CO
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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