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General NPI Number Information
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NPI Number | 1184014110
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Entity Type | Organization
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Legal Business Name | HEALING TRADITIONS BODYWORK, LLC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 26085 AMY CIR
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City | CONIFER
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State | CO
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Zip | 80433-6113
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Country | US
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Telephone | 720-244-7217
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Fax |
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Provider Business Mailing Address
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Address Line | 28186 HIGHWAY 74 UNIT 7
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City | EVERGREEN
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State | CO
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Zip | 80439-5775
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Country | US
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Telephone | 720-244-7217
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARY DAVIS
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Credential | LMT
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Telephone | 720-244-7217
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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.0004270
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License Number State | CO
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