Provider Demographics
NPI:1780942441
Name:MASSINO, BETTY ANN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:MASSINO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:PRESTIPINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERPAIST
Mailing Address - Street 1:4112 OUTLOOK BLVD
Mailing Address - Street 2:SUITE #96
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1667
Mailing Address - Country:US
Mailing Address - Phone:719-562-6200
Mailing Address - Fax:719-562-6225
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:SUITE #96
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-562-6200
Practice Address - Fax:719-562-6225
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5342OtherSTATE LICENSE