Provider Demographics
NPI:1922832641
Name:SOMMERVILLE, STAR ANN (LMT)
Entity type:Individual
Prefix:MRS
First Name:STAR
Middle Name:ANN
Last Name:SOMMERVILLE
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 1:3252 F RD UNIT 1172
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-2048
Mailing Address - Country:US
Mailing Address - Phone:970-623-6921
Mailing Address - Fax:
Practice Address - Street 1:484 TRACY DR APT 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-8844
Practice Address - Country:US
Practice Address - Phone:530-616-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist