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General NPI Number Information
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NPI Number | 1346495066
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Entity Type | Organization
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Legal Business Name | CELESTIAL PYRAMID MASSAGETHERAPY LLC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 9809 CANDELARIA RD NE STE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1459
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Country | US
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Telephone | 505-296-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 9809 CANDELARIA RD NE STE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1459
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Country | US
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Telephone | 505-296-2887
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/MASSAGE THERAPIST
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Name | MR. ALLEN WADE BRAITHWAITE
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Credential | LMT
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Telephone | 505-296-2887
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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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