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General NPI Number Information
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NPI Number | 1356629372
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Entity Type | Organization
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Legal Business Name | PARKER WELLNESS, LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 19731 E PIKES PEAK CT STE 201
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City | PARKER
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State | CO
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Zip | 80138-7401
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Country | US
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Telephone | 303-913-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 19731 E PIKES PEAK CT STE 201
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City | PARKER
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State | CO
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Zip | 80138-7401
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Country | US
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Telephone | 303-913-8686
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED MASSAGE THERAPIST
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Name | CHRISTINE JACOBSEN
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Credential | LMT
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Telephone | 303-913-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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