Provider Demographics
NPI:1689223984
Name:HARGIS, ELSIE VAUGHN (LMT)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:VAUGHN
Last Name:HARGIS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7143
Mailing Address - Country:US
Mailing Address - Phone:719-231-5280
Mailing Address - Fax:
Practice Address - Street 1:7630 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7143
Practice Address - Country:US
Practice Address - Phone:719-231-5280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60964071225700000X
COMT.0022889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist