Basic Information
| Provider Information | |||||||||
| NPI: | 1730427121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDDIHY-GARNER | ||||||||
| FirstName: | NATHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4252 BROEMEL AVE | ||||||||
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| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800207926 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 290 NICKEL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034609151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2013 | ||||||||
| LastUpdateDate: | 01/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 2555 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.