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General NPI Number Information
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NPI Number | 1952648669
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Entity Type | Organization
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Legal Business Name | MERIDIAN MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 1660 RACE ST
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City | DENVER
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State | CO
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Zip | 80206-1112
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Country | US
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Telephone | 720-998-2699
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 S JACKSON ST
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City | DENVER
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State | CO
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Zip | 80210-2131
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT ALEXANDER
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Credential | LMT
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Telephone | 720-998-2699
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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 | 10735
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License Number State | CO
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