Provider Demographics
NPI:1194498311
Name:MASTIN, KATIE (LMT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MASTIN
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 1:4951 S FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILLS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2017
Mailing Address - Country:US
Mailing Address - Phone:303-740-8203
Mailing Address - Fax:
Practice Address - Street 1:4951 S FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:CHERRY HILLS VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2017
Practice Address - Country:US
Practice Address - Phone:303-740-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0024330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMT.0024330OtherMASSAGE THERAPY LICENSE NUMBER