MEDICARE: PEACEFUL SPIRIT THERAPEUTIC MASSAGE CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT-03724	AZ

General Provider Information

NPI Number	:	1013128388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL SPIRIT THERAPEUTIC MASSAGE CENTERS LLC

Provider Business Mailing Address
First Line	:	2930 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARA CONCORDIA
Credential	:
Telephone Number	:	520-320-1953

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	10/11/2023

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