MEDICARE: CENTER FOR NEUROMUSCULAR MASSAGE THERAPY

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	6745	CO
2	174400000X	Specialist	12963	CO

General Provider Information

NPI Number	:	1730474255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NEUROMUSCULAR MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	3955 E EXPOSITION AVE
Second Line	:	SUITE 320
City	:	DENVER
State	:	CO
Zip	:	80209-5033
Country	:	US
Telephone Number	:	303-777-1151
Fax Number	:	303-777-3112

Provider Business Practice Location Address
First Line	:	3955 E EXPOSITION AVE
Second Line	:	SUITE 320
City	:	DENVER
State	:	CO
Zip	:	80209-5033
Country	:	US
Telephone Number	:	303-777-1151
Fax Number	:	303-777-3112

Authorized Official
Title or Position	:	OWNER
Name	:	ELENA ILIEVA PASKOVA
Credential	:	PT, LMT
Telephone Number	:	303-777-1151

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	07/02/2014

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Directions to “CENTER FOR NEUROMUSCULAR MASSAGE THERAPY ” Practice Location

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