Provider Demographics
NPI:1871749564
Name:SMITH, MONICA LYNN (CMT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3100
Mailing Address - Country:US
Mailing Address - Phone:970-481-0770
Mailing Address - Fax:
Practice Address - Street 1:HARTSHORN HEALTH SERVICE
Practice Address - Street 2:COLORADO STATE UNIVERSITY
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist