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General NPI Number Information
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NPI Number | 1447589213
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Entity Type | Organization
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Legal Business Name | ASPEN WELLNESS LLC
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 85 W. MILL STREET
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City | BAYFIELD
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State | CO
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Zip | 81122
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Country | US
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Telephone | 970-884-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 82 DEER RIDGE DR
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City | BAYFIELD
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State | CO
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Zip | 81122-9418
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Country | US
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Telephone | 970-884-8900
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JASON DOUGLAS MCCLINTOCK
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Credential | LMT
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Telephone | 970-884-8900
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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 | 3591
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3592
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License Number State | CO
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