Healthcare Provider Details

I. General information

NPI: 1437212925
Provider Name (Legal Business Name): STANDLEY LAKE MASSAGE THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 WADSWORTH BLVD SUITE A
ARVADA CO
80003-0928
US

IV. Provider business mailing address

8725 WADSWORTH BLVD SUITE A
ARVADA CO
80003-0928
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-7298
  • Fax: 303-940-8330
Mailing address:
  • Phone: 303-425-7298
  • Fax: 303-940-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name: KATHRYN ANNE STEWART
Title or Position: CENTER DIRECTOR
Credential: CMT
Phone: 303-425-7298