Individual
ERIC DEFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5470 HYGIENE RD, LONGMONT, CO 80503-9150
(970) 818-1567
Mailing address
5470 HYGIENE RD, LONGMONT, CO 80503-9150
(970) 818-1567
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0018510
CO
Other
Enumeration date
10/02/2021
Last updated
10/02/2021
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