Healthcare Provider Details

I. General information

NPI: 1881228856
Provider Name (Legal Business Name): RELAXOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 W COMBS RD STE 103
SAN TAN VALLEY AZ
85140-9106
US

IV. Provider business mailing address

85 W COMBS RD STE 103
SAN TAN VALLEY AZ
85140-9106
US

V. Phone/Fax

Practice location:
  • Phone: 480-816-7446
  • Fax:
Mailing address:
  • Phone: 480-816-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: AVA MARIE AMESCUA
Title or Position: MANAGER
Credential: LAC. LMT
Phone: 720-291-3102