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General NPI Number Information
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NPI Number | 1326312117
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Entity Type | Organization
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Legal Business Name | TRANSITIONS CLINIC
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 1056 EAGLERIDGE BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2159
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Country | US
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Telephone | 719-947-5846
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 CYPRESS ST
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City | PUEBLO
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State | CO
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Zip | 81004-2503
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Country | US
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Telephone | 719-406-0295
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAD D CHILDERS
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Credential | MASSAGE THERAPIST
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Telephone | 719-947-5846
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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 |
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License Number State |
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