Individual
MR. TEAGAN CLARK BALLINLEE DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2130 MOUNTAIN VIEW AVE STE 205, LONGMONT, CO 80501-3177
(303) 835-7882
Mailing address
1065 REDBUD CIR, LONGMONT, CO 80503-7351
(469) 426-5542
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0025597
CO
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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