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General NPI Number Information
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NPI Number | 1790164515
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Entity Type | Organization
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Legal Business Name | WELL WITHIN HEALING ARTS LLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 910 PLATEAU RD
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City | LONGMONT
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State | CO
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Zip | 80504-7615
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Country | US
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Telephone | 970-596-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 910 PLATEAU RD
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City | LONGMONT
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State | CO
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Zip | 80504-7615
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Country | US
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Telephone | 970-596-7585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REILLY JERNIGAN
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Credential | LAC
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Telephone | 970-596-7585
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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 | MT-0004081
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACU-0001867
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License Number State | CO
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