Provider Demographics
NPI:1295219806
Name:INTUITIVE SCIENCE HOLISTIC MASSAGE CENTER, LLC
Entity Type:Organization
Organization Name:INTUITIVE SCIENCE HOLISTIC MASSAGE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:GAHLEN
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, LMT, MMP, CNMT
Authorized Official - Phone:719-964-7063
Mailing Address - Street 1:2025 N NORWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-5668
Mailing Address - Country:US
Mailing Address - Phone:719-281-3473
Mailing Address - Fax:
Practice Address - Street 1:2025 N NORWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-5668
Practice Address - Country:US
Practice Address - Phone:719-281-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty