Provider Demographics
NPI:1194829614
Name:WESTSIDE MYOFASCIAL CENTER LLC
Entity Type:Organization
Organization Name:WESTSIDE MYOFASCIAL CENTER LLC
Other - Org Name:HEALING SOLUTIONS ALTERNATIVE WELLNESS CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT, TPMT
Authorized Official - Phone:505-792-2592
Mailing Address - Street 1:4011 BARBARA LOOP SE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1039
Mailing Address - Country:US
Mailing Address - Phone:505-792-2592
Mailing Address - Fax:505-792-2814
Practice Address - Street 1:4011 BARBARA LOOP SE
Practice Address - Street 2:SUITE 108
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1039
Practice Address - Country:US
Practice Address - Phone:505-792-2592
Practice Address - Fax:505-792-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 225400000X
NM3940225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty