Provider Demographics
NPI:1154166981
Name:MALDONADO, JUANA (LMT)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:MALDONADO
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 1:907 30TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5100
Mailing Address - Country:US
Mailing Address - Phone:970-518-4871
Mailing Address - Fax:877-731-3312
Practice Address - Street 1:907 30TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5100
Practice Address - Country:US
Practice Address - Phone:970-518-4871
Practice Address - Fax:877-731-3312
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist