Individual
MR. JOE HENRY LEGOLVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
5912 S CODY ST STE 111, LITTLETON, CO 80123-9541
(720) 220-1687
Mailing address
9691 W COCO CIR UNIT 203, LITTLETON, CO 80128-9272
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0008220
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20161265269
CERTIFICATE OF GOOD STANDING
—
Enumeration date
07/19/2018
Last updated
07/19/2018
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