Provider Demographics
NPI:1497595979
Name:GOMEZ, SYLVESTER II (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:
Last Name:GOMEZ
Suffix:II
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9262 KATHI CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2073
Mailing Address - Country:US
Mailing Address - Phone:719-351-8560
Mailing Address - Fax:
Practice Address - Street 1:9262 KATHI CREEK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2073
Practice Address - Country:US
Practice Address - Phone:719-351-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist