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General NPI Number Information
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NPI Number | 1205224987
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Entity Type | Organization
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Legal Business Name | MASSAGE CONNECTION, LLC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 190 TALISMAN DR # D7
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-9171
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Country | US
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Telephone | 970-507-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 55 BLUE HERON CIR
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8181
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Country | US
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Telephone | 970-507-0189
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RHONDA ENTZ
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Credential | LMT
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Telephone | 970-507-0189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MT0001963
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License Number State | CO
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