Provider Demographics
NPI:1568268654
Name:MIRAS, KRYSTLE JASMINE (LMT)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:JASMINE
Last Name:MIRAS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 W 166TH DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8890
Mailing Address - Country:US
Mailing Address - Phone:443-513-8045
Mailing Address - Fax:
Practice Address - Street 1:4704 HARLAN ST STE 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7411
Practice Address - Country:US
Practice Address - Phone:756-720-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-0026916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist