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NPI Code Detail

MEDICARE: GODS LION DIVINE MASSAGE & FITNESS

MEDICARE: GODS LION DIVINE MASSAGE & FITNESS
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
1225700000XMassage Therapist11350CO

General Provider Information

NPI Number : 1356883227
Entity Type Code : Organization
Provider Name (Legal Business Name) : GODS LION DIVINE MASSAGE & FITNESS
Provider Business Mailing Address
First Line : 5446 N ACADEMY BLVD
Second Line : SUITE 104
City : COLORADO SPRINGS
State : CO
Zip : 80918-3668
Country : US
Telephone Number : 719-354-8347
Fax Number : 719-265-5221
Provider Business Practice Location Address
First Line : 5446 N ACADEMY BLVD
Second Line : SUITE 104
City : COLORADO SPRINGS
State : CO
Zip : 80918-3668
Country : US
Telephone Number : 719-354-8347
Fax Number : 719-265-5221
Authorized Official
Title or Position : PRESIDENT/PROVIDER
Name : KRISTIN L JONES
Credential :
Telephone Number : 719-354-8347
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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Directions to “GODS LION DIVINE MASSAGE & FITNESS ” Practice Location

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