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General NPI Number Information
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NPI Number | 1164850913
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Entity Type | Organization
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Legal Business Name | BAYFIELD MASSAGE
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 40031 US HIGHWAY 160 SUITE C
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City | BAYFIELD
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State | CO
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Zip | 81122-8746
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Country | US
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Telephone | 970-884-2455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | BAYFIELD
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State | CO
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Zip | 81122-0622
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Country | US
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Telephone | 970-884-2455
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORETTA G EDWARDS
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Credential |
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Telephone | 970-884-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MT.0011270
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License Number State | CO
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