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General NPI Number Information
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NPI Number | 1639333651
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Entity Type | Organization
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Legal Business Name | TRANQUIL LOTUS MASSAGE
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 1508 COLLYER ST
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City | LONGMONT
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State | CO
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Zip | 80501-2820
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Country | US
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Telephone | 720-891-3446
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 COLLYER ST
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City | LONGMONT
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State | CO
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Zip | 80501-2820
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Country | US
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Telephone | 720-891-3446
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA SLATTERY
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Credential |
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Telephone | 720-891-3446
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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 | 17856
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License Number State | FL
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