Provider Demographics
NPI:1205688157
Name:BOURLAKOV, MELANIE (LMT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BOURLAKOV
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 1:12792 W ALAMEDA PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2846
Mailing Address - Country:US
Mailing Address - Phone:303-953-5200
Mailing Address - Fax:
Practice Address - Street 1:12792 W ALAMEDA PKWY STE E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2846
Practice Address - Country:US
Practice Address - Phone:303-953-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0026438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist