Healthcare Provider Details

I. General information

NPI: 1467060772
Provider Name (Legal Business Name): MILE HIGH HOLISTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 KIPLING ST
LAKEWOOD CO
80215-2822
US

IV. Provider business mailing address

2245 IRVING ST
DENVER CO
80211-5048
US

V. Phone/Fax

Practice location:
  • Phone: 720-999-8550
  • Fax: 303-379-4150
Mailing address:
  • Phone: 720-209-4083
  • Fax: 303-379-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE WHALEN
Title or Position: OWNER
Credential: LMT
Phone: 720-209-4083