Provider Demographics
NPI:1568739860
Name:MEDICAL MASSAGE & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:MEDICAL MASSAGE & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RMT
Authorized Official - Phone:970-667-2277
Mailing Address - Street 1:832 W EISENHOWER BLVD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3134
Mailing Address - Country:US
Mailing Address - Phone:970-667-2277
Mailing Address - Fax:
Practice Address - Street 1:832 W EISENHOWER BLVD
Practice Address - Street 2:SUITE B-1
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3134
Practice Address - Country:US
Practice Address - Phone:970-667-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty