Healthcare Provider Details

I. General information

NPI: 1306238324
Provider Name (Legal Business Name): TREE OF LIFE MASSAGE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE SUITE 202A
ALBUQUERQUE NM
87110-1437
US

IV. Provider business mailing address

5310 HOMESTEAD RD NE SUITE 202A
ALBUQUERQUE NM
87110-1437
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-9910
  • Fax:
Mailing address:
  • Phone: 505-205-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6324
License Number StateNM

VIII. Authorized Official

Name: CHRYSTAL B COPELAND
Title or Position: OWNER
Credential: LMT
Phone: 505-205-9910