Provider Demographics
NPI:1063061828
Name:HAINES, MERYL ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:MERYL
Middle Name:ELIZABETH
Last Name:HAINES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 W 38TH AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4971
Mailing Address - Country:US
Mailing Address - Phone:720-404-6467
Mailing Address - Fax:
Practice Address - Street 1:1320 SIMMS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-4478
Practice Address - Country:US
Practice Address - Phone:720-404-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0019335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist