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General NPI Number Information
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NPI Number | 1578314605
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Entity Type | Organization
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Legal Business Name | MCRUB INC DBA PRO-ACTIVE MASSAGE THERAPY
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1119 N WAHSATCH AVE STE 1
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2485
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Country | US
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Telephone | 719-641-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 N WAHSATCH AVE STE 1
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2485
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Country | US
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Telephone | 719-641-8987
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT E. MCATEE
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Credential |
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Telephone | 719-641-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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