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General NPI Number Information
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NPI Number | 1861826232
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SAGE MASSAGE, LLC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 7019 S KNOLLS WAY
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City | CENTENNIAL
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State | CO
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Zip | 80122-1732
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Country | US
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Telephone | 970-445-8137
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Fax |
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Provider Business Mailing Address
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Address Line | 7019 S KNOLLS WAY
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City | CENTENNIAL
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State | CO
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Zip | 80122-1732
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Country | US
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Telephone | 970-445-8137
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Fax |
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Authorized Official
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Title or Position | CERTIFIED MASSAGE THERAPIST
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Name | RIKKI RENEA VIGIL
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Credential | CMT
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Telephone | 970-445-8137
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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.0012925
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License Number State | CO
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