Individual
LYDIA M. PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.M.T.
Contact information
Practice address
2226 SOUTH FRASER STREET,, UNIT 5, AURORA, CO 80014-4534
(303) 695-1609
(303) 695-0382
Mailing address
1848 S. GENOA STREET, AURORA, CO 80017
(303) 564-7032
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9091, MT
CO
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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