Healthcare Provider Details

I. General information

NPI: 1487561171
Provider Name (Legal Business Name): DIVINE GLOW MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 GALLEY RD STE 110
COLORADO SPRINGS CO
80909-4353
US

IV. Provider business mailing address

3510 GALLEY RD STE 110
COLORADO SPRINGS CO
80909-4353
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-9498
  • Fax: 303-604-4099
Mailing address:
  • Phone: 719-571-9498
  • Fax: 303-604-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMANTHA J GOEKE
Title or Position: OWNER
Credential: MASSAGE THERAPIST
Phone: 719-571-9498