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General NPI Number Information
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NPI Number | 1700328945
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Entity Type | Organization
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Legal Business Name | BODY BALANCE BLISS
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 200 CAPITOL ST.
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City | EAGLE
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State | CO
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Zip | 81631
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Country | US
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Telephone | 512-415-8537
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6944
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City | AVON
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State | CO
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Zip | 81620-6944
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Country | US
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Telephone | 512-415-8537
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Fax |
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Authorized Official
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Title or Position | OWNER, MASSAGE THERAPIST, YOGA INST
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Name | KATHRYN CUEVA
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Credential | MT
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Telephone | 512-415-8537
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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 | 0012533
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License Number State | CO
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