Provider Demographics
NPI:1497063796
Name:STRUCTURE THERAPEUTIC MASSAGE & BODYWORK, INC.
Entity Type:Organization
Organization Name:STRUCTURE THERAPEUTIC MASSAGE & BODYWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:FALU-BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-271-7931
Mailing Address - Street 1:2107 TEMPLETON GAP RD
Mailing Address - Street 2:SUITE D.
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7100
Mailing Address - Country:US
Mailing Address - Phone:719-271-7931
Mailing Address - Fax:
Practice Address - Street 1:2107 TEMPLETON GAP RD
Practice Address - Street 2:SUITE D.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7100
Practice Address - Country:US
Practice Address - Phone:719-271-7931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty