Provider Demographics
NPI:1043810229
Name:MINEAR, RAE MARIE (LMT, CNHP, CHS, ND)
Entity type:Individual
Prefix:MISS
First Name:RAE
Middle Name:MARIE
Last Name:MINEAR
Suffix:
Gender:F
Credentials:LMT, CNHP, CHS, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S YUKON ST STE 340
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4333
Mailing Address - Country:US
Mailing Address - Phone:720-878-3773
Mailing Address - Fax:
Practice Address - Street 1:1075 S YUKON ST STE 340
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4333
Practice Address - Country:US
Practice Address - Phone:720-878-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0006709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist