Provider Demographics
NPI:1972335230
Name:SANTOS HAYNES, AUSTIN JUDD (LMT, NMT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JUDD
Last Name:SANTOS HAYNES
Suffix:
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 ARAPAHOE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1359
Mailing Address - Country:US
Mailing Address - Phone:970-596-0270
Mailing Address - Fax:
Practice Address - Street 1:5600 ARAPAHOE AVE STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1359
Practice Address - Country:US
Practice Address - Phone:970-596-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist