MEDICARE: PRICKLY PEAR MEDICAL MASSAGE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225700000X	Massage Therapist
3	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1699591768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRICKLY PEAR MEDICAL MASSAGE LLC

Provider Business Mailing Address
First Line	:	1203 COLORADO AVE STE B
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4630
Country	:	US
Telephone Number	:	970-592-8165
Fax Number	:	970-632-6153

Provider Business Practice Location Address
First Line	:	1203 COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4630
Country	:	US
Telephone Number	:	970-592-8165
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA MARCHESE
Credential	:
Telephone Number	:	970-778-5448

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	12/31/2024

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