Healthcare Provider Details

I. General information

NPI: 1093051658
Provider Name (Legal Business Name): ELLEN MASELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 STEELE ST STE 300
DENVER CO
80206-5243
US

IV. Provider business mailing address

250 STEELE ST STE 300
DENVER CO
80206-5243
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-6878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3259
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTA0012311
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: