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General NPI Number Information
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NPI Number | 1639422751
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Entity Type | Organization
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Legal Business Name | LAS MANOS MASSAGE LLC
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 301 E. MAIN ST. SUITE 10
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City | BUENA VISTA
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State | CO
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Zip | 81211
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Country | US
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Telephone | 719-395-7807
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5039
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City | BUENA VISTA
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State | CO
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Zip | 81211-5039
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Country | US
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Telephone | 719-395-7807
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM MCQUEEN
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Credential | LMT
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Telephone | 719-395-7807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 1006
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License Number State | CO
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