1205950292 NPI number — DAVID WILLIAM DOLAN L.M.T.-MASSAGE THERA

Table of content: DAVID WILLIAM DOLAN L.M.T.-MASSAGE THERA (NPI 1205950292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205950292 NPI number — DAVID WILLIAM DOLAN L.M.T.-MASSAGE THERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLAN
Provider First Name:
DAVID
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.-MASSAGE THERA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205950292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2462
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAGOSA SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81147-2462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-947-0112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 RIVERGATE
Provider Second Line Business Practice Location Address:
SUITE 95
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-7487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-947-0112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA# 10055 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: 7499 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593341785 . This is a "FEIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7499 . This is a "LICENSED MASSAGE THERAPIST" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: MA# 10055 . This is a "LIC. MASSAGE THERAPIST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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