Healthcare Provider Details

I. General information

NPI: 1346495066
Provider Name (Legal Business Name): CELESTIAL PYRAMID MASSAGETHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 CANDELARIA RD NE STE 2B
ALBUQUERQUE NM
87112-1459
US

IV. Provider business mailing address

9809 CANDELARIA RD NE STE 2B
ALBUQUERQUE NM
87112-1459
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-2887
  • Fax:
Mailing address:
  • Phone: 505-296-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALLEN WADE BRAITHWAITE
Title or Position: CO-OWNER/MASSAGE THERAPIST
Credential: LMT
Phone: 505-296-2887