Provider Demographics
NPI:1316265093
Name:WATKINS, MATTHEW JAY (LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:WATKINS
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 1:4899 S DUDLEY ST APT J23
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7639
Mailing Address - Country:US
Mailing Address - Phone:720-675-9740
Mailing Address - Fax:
Practice Address - Street 1:4899 S DUDLEY ST APT J23
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7639
Practice Address - Country:US
Practice Address - Phone:720-675-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist