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General NPI Number Information
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NPI Number | 1619109113
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SPIRIT HEALING ARTS CENTER
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 713 3RD AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5926
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Country | US
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Telephone | 303-772-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 713 3RD AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | SUSAN MALIN
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Credential | RMT
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Telephone | 303-772-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 1340
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License Number State | CO
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