Provider Demographics
NPI:1760200844
Name:HUMES, CHANTRICE CHANAE' (LMT)
Entity type:Individual
Prefix:
First Name:CHANTRICE
Middle Name:CHANAE'
Last Name:HUMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 COLONY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2230
Mailing Address - Country:US
Mailing Address - Phone:719-419-0346
Mailing Address - Fax:
Practice Address - Street 1:3314 MESA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1036
Practice Address - Country:US
Practice Address - Phone:719-428-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0026475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist