Individual
MR. RYAN SAMUEL PACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 9TH AVE, SUITE 5, LONGMONT, CO 80501-4598
(303) 590-4969
Mailing address
107 CARIBOU PL, LONGMONT, CO 80504-1206
(303) 590-4969
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2746
CO
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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