Provider Demographics
NPI:1073843017
Name:WINGS THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:WINGS THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKE
Authorized Official - Suffix:
Authorized Official - Credentials:RMT CNMT
Authorized Official - Phone:719-641-3548
Mailing Address - Street 1:28 LUXURY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3300
Mailing Address - Country:US
Mailing Address - Phone:719-641-3548
Mailing Address - Fax:719-548-7425
Practice Address - Street 1:7608 N UNION BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3886
Practice Address - Country:US
Practice Address - Phone:719-641-3548
Practice Address - Fax:719-548-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty