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General NPI Number Information
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NPI Number | 1669852554
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Entity Type | Organization
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Legal Business Name | SOMA HEALING MASSAGE THERAPY, LLC
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 315 W SOUTH BOULDER RD SUITE 209
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City | LOUISVILLE
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State | CO
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Zip | 80027-1156
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Country | US
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Telephone | 720-840-3650
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Fax |
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Provider Business Mailing Address
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Address Line | 1892 MALLARD DR
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City | SUPERIOR
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State | CO
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Zip | 80027-4434
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Country | US
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Telephone | 720-840-3650
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Fax |
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Authorized Official
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Title or Position | SPORTS/ORTHOPEDIC MASSAGE THERAPIST
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Name | ELIZABETH CARD
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Credential | RMT
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Telephone | 720-840-3650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 10824
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License Number State | CO
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