Basic Information
| Provider Information | |||||||||
| NPI: | 1568082154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGARE | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2183 HACKBERRY CIR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805010920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129929164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 S MAIN ST STE C | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2020 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT.0023353 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.