Collette Kae Peterson, CMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

2564 Issued in CO

Practice address

31480 Brookline Rd
Evergreen, CO 80439-8946

Phone

(303) 928-9860

NPI assigned

Sep 24, 2011

Last updated

Sep 24, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Collette Kae Klinkopf Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316822400000",
    "number": "1093098170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31480 BROOKLINE RD",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804398946",
            "telephone_number": "303-928-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31480 BROOKLINE RD",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804398946",
            "telephone_number": "303-928-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "COLLETTE",
        "middle_name": "KAE",
        "name_prefix": "Ms.",
        "credential": "CMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-24",
        "last_updated": "2011-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CO",
            "license": "2564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLETTE",
            "last_name": "KLINKOPF",
            "middle_name": "KAE",
            "prefix": "MS.",
            "credential": "CMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Massage Therapist in Evergreen, CO
• Providers in Evergreen, CO by specialty
• Massage Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.