Provider Demographics
NPI:1134479504
Name:NFR NEURO FASCIAL RE EDUCATION AND MASSAGE LLC
Entity Type:Organization
Organization Name:NFR NEURO FASCIAL RE EDUCATION AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:REMES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:720-505-1541
Mailing Address - Street 1:4417 SAN MARCO DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4165
Mailing Address - Country:US
Mailing Address - Phone:720-505-1541
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST
Practice Address - Street 2:SUITE 220A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:720-505-1541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NFR NEURO FASCIAL RE EDUCATION AND MASSAGE GARY REMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT 10707305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1750583472OtherMASSAGE