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General NPI Number Information
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NPI Number | 1902595846
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Entity Type | Organization
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Legal Business Name | CHRYSALISIS; A NEW SHIFT IN LIFE
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 411 COLORADO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2010
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Country | US
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Telephone | 804-240-1964
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Fax | 303-443-0500
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Provider Business Mailing Address
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Address Line | 4005 ONEAL AVE APT 12
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City | PUEBLO
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State | CO
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Zip | 81005-2788
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Country | US
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Telephone | 804-240-1964
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Fax | 303-443-0500
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | BARBARA RAE FRYE
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Credential | LMT
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Telephone | 804-240-1964
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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 |
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License Number State |
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