Provider Demographics
NPI:1053007856
Name:THOMAS, JESSICA (LMT, OMT, CMLDT, CLT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT, OMT, CMLDT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1033
Mailing Address - Country:US
Mailing Address - Phone:303-228-3177
Mailing Address - Fax:720-407-5142
Practice Address - Street 1:2550 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1033
Practice Address - Country:US
Practice Address - Phone:303-228-3177
Practice Address - Fax:720-407-5142
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025123225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist