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General NPI Number Information
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NPI Number | 1164801049
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Entity Type | Organization
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Legal Business Name | ULTIMATE MASSAGE SERVICES BY NORMA LLC
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Dates
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Enumeration Date | 05/25/2015
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Last Update Date | 05/25/2015
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Provider Practice Location Address
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Address Line | 11172 HURON ST 20-C
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City | NORTHGLENN
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State | CO
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Zip | 80234-4380
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Country | US
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Telephone | 720-443-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 11172 HURON ST 20-C
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City | NORTHGLENN
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State | CO
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Zip | 80234-4380
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Country | US
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Telephone | 720-443-0601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NORMA JEAN HEIDE
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Credential | LMT
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Telephone | 720-443-0601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-0001027
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License Number State | CO
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