Provider Demographics
NPI:1275990228
Name:MOUNTAIN HARMONY YOGA AND BODYWORK
Entity Type:Organization
Organization Name:MOUNTAIN HARMONY YOGA AND BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, LMT
Authorized Official - Phone:719-588-5444
Mailing Address - Street 1:5130 SIERRA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9734
Mailing Address - Country:US
Mailing Address - Phone:719-588-5444
Mailing Address - Fax:
Practice Address - Street 1:815 WEST AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3028
Practice Address - Country:US
Practice Address - Phone:719-588-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0018293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty