Individual
MARY ELLEN (NMN) LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CNMT
Contact information
Practice address
2020 W COLORADO AVE, SUITE 101, COLORADO SPRINGS, CO 80904-3882
(719) 660-1686
Mailing address
656 GLEN EYRIE CIR, COLORADO SPRINGS, CO 80904-2139
(719) 578-3012
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
709188
CO
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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