Individual
AMANDA S SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1918 S LEMAY AVE STE A, FORT COLLINS, CO 80525-1295
(970) 286-0033
Mailing address
512 AFFIRMED CT, FORT COLLINS, CO 80526-6306
(307) 534-6971
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0010086
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010086
STATE OF COLORADO
CO
Enumeration date
04/02/2018
Last updated
04/02/2018
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