Provider Demographics
NPI:1093046047
Name:MISHA1
Entity Type:Organization
Organization Name:MISHA1
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE PINEY CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERHIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-529-3500
Mailing Address - Street 1:15446 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3005
Mailing Address - Country:US
Mailing Address - Phone:720-529-3500
Mailing Address - Fax:720-870-9146
Practice Address - Street 1:15446 E ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-3005
Practice Address - Country:US
Practice Address - Phone:720-529-3500
Practice Address - Fax:720-870-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty