Healthcare Provider Details

I. General information

NPI: 1730474255
Provider Name (Legal Business Name): CENTER FOR NEUROMUSCULAR MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E EXPOSITION AVE SUITE 320
DENVER CO
80209-5033
US

IV. Provider business mailing address

3955 E EXPOSITION AVE SUITE 320
DENVER CO
80209-5033
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-1151
  • Fax: 303-777-3112
Mailing address:
  • Phone: 303-777-1151
  • Fax: 303-777-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12963
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6745
License Number StateCO

VIII. Authorized Official

Name: ELENA ILIEVA PASKOVA
Title or Position: OWNER
Credential: PT, LMT
Phone: 303-777-1151