Provider Demographics
NPI:1699783704
Name:LITASI, SHERRY J (LMT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:LITASI
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 1:48 KINGSTON MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NM
Mailing Address - Zip Code:88042-9514
Mailing Address - Country:US
Mailing Address - Phone:303-324-2305
Mailing Address - Fax:
Practice Address - Street 1:48 KINGSTON MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NM
Practice Address - Zip Code:88042
Practice Address - Country:US
Practice Address - Phone:303-324-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT7423225700000X
COMT596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1021764OtherDENVER BUSINESS LICENSE