Healthcare Provider Details

I. General information

NPI: 1831705177
Provider Name (Legal Business Name): CORE MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ACADEMY CIR STE F
COLORADO SPRINGS CO
80909-1674
US

IV. Provider business mailing address

2120 ACADEMY CIR STE F
COLORADO SPRINGS CO
80909-1674
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-3399
  • Fax:
Mailing address:
  • Phone: 719-373-3399
  • Fax: 719-960-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID ABBOTT
Title or Position: OWNER
Credential: SMT NMT LMT
Phone: 719-373-3399