Healthcare Provider Details

I. General information

NPI: 1982935946
Provider Name (Legal Business Name): MISHA1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 E ILIFF AVE STE A
AURORA CO
80014-4538
US

IV. Provider business mailing address

15230 E ILIFF AVE STE A
AURORA CO
80014-4538
US

V. Phone/Fax

Practice location:
  • Phone: 303-751-1881
  • Fax: 303-695-1198
Mailing address:
  • Phone: 303-751-1881
  • Fax: 303-695-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELE MERHIB
Title or Position: OWNER
Credential:
Phone: 303-751-1881