Provider Demographics
NPI:1578314605
Name:MCRUB INC DBA PRO-ACTIVE MASSAGE THERAPY
Entity Type:Organization
Organization Name:MCRUB INC DBA PRO-ACTIVE MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCATEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-641-8987
Mailing Address - Street 1:1119 N WAHSATCH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2485
Mailing Address - Country:US
Mailing Address - Phone:719-641-8987
Mailing Address - Fax:
Practice Address - Street 1:1119 N WAHSATCH AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2485
Practice Address - Country:US
Practice Address - Phone:719-641-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center