Provider Demographics
NPI:1104328079
Name:MAYBE, LUIS OCTAVIO (LMT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:OCTAVIO
Last Name:MAYBE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 E HAMPDEN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4931
Mailing Address - Country:US
Mailing Address - Phone:720-589-1824
Mailing Address - Fax:
Practice Address - Street 1:8811 E HAMPDEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4931
Practice Address - Country:US
Practice Address - Phone:720-589-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist