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General NPI Number Information
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NPI Number | 1457740276
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Entity Type | Organization
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Legal Business Name | BRIGHT STARR THERAPUETIC MASSAGE LLC
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 26291 MAIN ST
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City | CONIFER
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State | CO
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Zip | 80433-8500
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Country | US
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Telephone | 720-878-1236
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Fax |
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Provider Business Mailing Address
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Address Line | 26291 MAIN ST
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City | CONIFER
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State | CO
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Zip | 80433-8500
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Country | US
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Telephone | 720-878-1236
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. TRACY LEE VERMILLION-HORN
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Credential | CMT
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Telephone | 720-878-1236
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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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