Healthcare Provider Details

I. General information

NPI: 1124635982
Provider Name (Legal Business Name): ENHANCED GLAMOUR DAY SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S 18TH AVE STE G
BRIGHTON CO
80601-2452
US

IV. Provider business mailing address

36 S 18TH AVE STE G
BRIGHTON CO
80601-2452
US

V. Phone/Fax

Practice location:
  • Phone: 720-864-4344
  • Fax:
Mailing address:
  • Phone: 720-753-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TINA NEUMILLER
Title or Position: OWMER/PARTNER
Credential: RN
Phone: 720-753-8375