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General NPI Number Information
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NPI Number | 1881984102
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Entity Type | Organization
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Legal Business Name | GREEN LEAF MASSAGE CENTER. LLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 11890 W.64TH AVENUE
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City | ARVADA
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State | CO
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Zip | 80004
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Country | US
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Telephone | 303-423-6091
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Fax |
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Provider Business Mailing Address
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Address Line | 11890 W.64TH AVENUE
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City | ARVADA
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State | CO
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Zip | 80004
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Country | US
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Telephone | 303-423-6091
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Fax |
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Authorized Official
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Title or Position | OWNR
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Name | DANETTE ANDREA SIRAVO
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Credential |
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Telephone | 303-423-6091
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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-9224
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License Number State | CO
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