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General NPI Number Information
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NPI Number | 1710355599
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Entity Type | Organization
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Legal Business Name | QUIET RIVER MASSAGE & BODYWORK
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 132 N WASHINGTON AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-3206
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Country | US
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Telephone | 928-273-6897
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Fax |
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Provider Business Mailing Address
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Address Line | 132 N WASHINGTON AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-3206
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Country | US
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Telephone | 928-273-6897
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Fax |
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Authorized Official
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Title or Position | MANUAL THERAPIST
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Name | MRS. LUCY HELEN COREY
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Credential | LMT NCMT
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Telephone | 928-273-6897
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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 | MT-11435
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MT-11435
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License Number State | AZ
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