Healthcare Provider Details

I. General information

NPI: 1396563011
Provider Name (Legal Business Name): ROSE MASSAGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N GREENWOOD ST
PUEBLO CO
81003-2927
US

IV. Provider business mailing address

955 N GREENWOOD ST
PUEBLO CO
81003-2927
US

V. Phone/Fax

Practice location:
  • Phone: 719-256-0797
  • Fax: 719-285-0781
Mailing address:
  • Phone: 719-256-0797
  • Fax: 719-285-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. AMY ROSE
Title or Position: OWNER
Credential: RN, LMT, CNMT
Phone: 719-821-0377