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General NPI Number Information
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NPI Number | 1831698943
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Entity Type | Organization
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Legal Business Name | MIND HAND BODY LLC
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Dates
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Enumeration Date | 02/03/2018
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 3578 HARTSEL DR # 579
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2103
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Country | US
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Telephone | 719-357-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 HARTSEL DR # 579
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2103
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Country | US
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Telephone | 719-357-5827
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | TERI HALEY
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Credential | LMT
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Telephone | 719-357-5827
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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.0021197
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License Number State | CO
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