Provider Demographics
NPI:1154692325
Name:QUEZAIRE, TAMARA (RMT)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:QUEZAIRE
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 BASELINE RD
Mailing Address - Street 2:#300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2366
Mailing Address - Country:US
Mailing Address - Phone:720-352-4069
Mailing Address - Fax:
Practice Address - Street 1:2935 BASELINE RD
Practice Address - Street 2:#300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2366
Practice Address - Country:US
Practice Address - Phone:720-352-4069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist