Provider Demographics
NPI:1598580243
Name:WEBB, LARAINE TAYLOR (LMT, NCBTMB, AAS)
Entity type:Individual
Prefix:
First Name:LARAINE
Middle Name:TAYLOR
Last Name:WEBB
Suffix:
Gender:F
Credentials:LMT, NCBTMB, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 DANCING MOON WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3892
Mailing Address - Country:US
Mailing Address - Phone:801-391-9769
Mailing Address - Fax:
Practice Address - Street 1:6350 DANCING MOON WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3892
Practice Address - Country:US
Practice Address - Phone:801-391-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026143225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist