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General NPI Number Information
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NPI Number | 1851664213
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 1701 KIPLING ST STE 105
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City | LAKEWOOD
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State | CO
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Zip | 80215-2848
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Country | US
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Telephone | 720-335-1118
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Fax | 303-238-5553
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Provider Business Mailing Address
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Address Line | 1701 KIPLING ST STE 105
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City | LAKEWOOD
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State | CO
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Zip | 80215-2848
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Country | US
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Telephone | 720-335-1118
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Fax | 303-238-5553
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. CANDACE ROISUM
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Credential |
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Telephone | 720-335-1118
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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 | 4244
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License Number State | CO
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