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General NPI Number Information
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NPI Number | 1093969792
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Entity Type | Organization
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Legal Business Name | MASSAGE SPACE, CO.
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4152 W SPRING CREEK PKWY STE 116
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City | PLANO
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State | TX
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Zip | 75024-5315
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Country | US
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Telephone | 972-612-5363
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Fax | 972-612-5782
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Provider Business Mailing Address
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Address Line | 4152 W SPRING CREEK PKWY STE 116
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City | PLANO
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State | TX
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Zip | 75024-5315
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Country | US
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Telephone | 972-612-5363
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Fax | 972-612-5782
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Authorized Official
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Title or Position | OWNER
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Name | ANATOLY V. KOLMAKOV
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Credential |
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Telephone | 972-612-5363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | TX
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