Jennifer Ann Moon
Individual provider Active NPI Massage Therapist · Security, CO
NPI 1568046472 · NPPES record last updated May 26, 2021
Key facts
- NPI
- 1568046472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT0019004 (CO)
- Practice address
- 413 Security Blvd
Ste D
Security, CO 80911 - Phone
- (171) 932-1486
- NPI assigned
- May 6, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT0019004 | CO | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT0019004 | CO | Yes |
Addresses
Primary practice location
413 Security Blvd
Ste D
Security, CO 80911
Mailing address
413 Security Blvd
Ste D
Security, CO 80911
Phone (719) 321-4863
Other providers in Security, CO
All providers in Security, CO · Massage Therapist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.