Healthcare Provider Details

I. General information

NPI: 1164752143
Provider Name (Legal Business Name): SOLLIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 S TOWER RD UNIT A
AURORA CO
80013-5704
US

IV. Provider business mailing address

3571 S TOWER RD UNIT A
AURORA CO
80013-5704
US

V. Phone/Fax

Practice location:
  • Phone: 303-400-4545
  • Fax: 303-400-8787
Mailing address:
  • Phone: 303-400-4545
  • Fax: 303-400-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FORREST BURDUE
Title or Position: OWNER
Credential:
Phone: 303-400-4545