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General NPI Number Information
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NPI Number | 1669354817
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Entity Type | Organization
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Legal Business Name | MUSCLE RESTORATION, INC.
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 4532 MCMURRY AVE UNIT 204
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City | FORT COLLINS
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State | CO
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Zip | 80525-8022
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Country | US
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Telephone | 402-363-1864
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 MCMURRY AVE UNIT 204
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City | FORT COLLINS
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State | CO
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Zip | 80525-8022
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Country | US
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Telephone | 402-363-1864
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JONAH OTTE
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Credential |
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Telephone | 970-449-9757
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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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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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