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General NPI Number Information
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NPI Number | 1891124673
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Entity Type | Organization
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Legal Business Name | ABSOLUTE BODY BALANCE
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 5921 N NEVADA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3549
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Country | US
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Telephone | 719-266-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 5921 N NEVADA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3549
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Country | US
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Telephone | 719-266-8884
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPY
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Name | LAURA PETERSON
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Credential | MT
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Telephone | 719-502-1477
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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 | 0010235
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License Number State | CO
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