Provider Demographics
NPI:1548811011
Name:MCMURTRY, ROY (LMT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:MCMURTRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 WAYWARD WIND DR
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9903
Mailing Address - Country:US
Mailing Address - Phone:719-355-8084
Mailing Address - Fax:
Practice Address - Street 1:273 WAYWARD WIND DR
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-9903
Practice Address - Country:US
Practice Address - Phone:719-355-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1972748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist