Provider Demographics
NPI:1053092551
Name:DEVILLIER, PAULA (LMT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:DEVILLIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:GAYATRI
Other - Middle Name:
Other - Last Name:DEVILLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3240 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2432
Mailing Address - Country:US
Mailing Address - Phone:720-648-5257
Mailing Address - Fax:
Practice Address - Street 1:2703 IRIS AVE FL 2
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2405
Practice Address - Country:US
Practice Address - Phone:720-648-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist