Healthcare Provider Details

I. General information

NPI: 1194913236
Provider Name (Legal Business Name): MEDICAL MASSAGE OF THE ROCKIES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 16TH ST STE 6M
GREELEY CO
80634-6862
US

IV. Provider business mailing address

3400 W 16TH ST STE 6M
GREELEY CO
80634-6862
US

V. Phone/Fax

Practice location:
  • Phone: 970-352-5716
  • Fax: 970-204-6812
Mailing address:
  • Phone: 970-352-5716
  • Fax: 970-204-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LINDA KAY OGILVIE
Title or Position: MEMBER
Credential: RN,CMT
Phone: 970-204-0516