Healthcare Provider Details

I. General information

NPI: 1598159998
Provider Name (Legal Business Name): TVP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 XAVIER ST
DENVER CO
80204-1022
US

IV. Provider business mailing address

1460 XAVIER ST
DENVER CO
80204-1022
US

V. Phone/Fax

Practice location:
  • Phone: 303-642-0376
  • Fax:
Mailing address:
  • Phone: 303-642-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT.0012979
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT.0012979
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMT.0012979
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMT.0012979
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMT.0012979
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMT.0012979
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMT.0012979
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0012979
License Number StateCO

VIII. Authorized Official

Name: JAMIE THOMAS
Title or Position: OWNER
Credential:
Phone: 303-642-0376