Provider Demographics
NPI:1154596443
Name:JAGODZINSKI, REBECCA JEANNE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNE
Last Name:JAGODZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:JAGODZINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:15993 E LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2717
Mailing Address - Country:US
Mailing Address - Phone:303-736-2661
Mailing Address - Fax:303-736-2661
Practice Address - Street 1:15993 E LOYOLA DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2717
Practice Address - Country:US
Practice Address - Phone:303-736-2661
Practice Address - Fax:303-736-2661
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist