MEDICARE: SOULRISE STUDIOS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1124674718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOULRISE STUDIOS LLC

Provider Business Mailing Address
First Line	:	2024 N 7TH ST STE 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2515
Country	:	US
Telephone Number	:	602-529-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2515
Country	:	US
Telephone Number	:	602-529-2215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHELA YU
Credential	:	LMT
Telephone Number	:	480-385-9493

Provider Enumeration Date	:	08/10/2019
Last Update Date	:	08/10/2019

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Directions to “SOULRISE STUDIOS LLC ” Practice Location

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