Provider Demographics
NPI:1598268252
Name:SPRINGS MEDICAL MASSAGE LLC
Entity Type:Organization
Organization Name:SPRINGS MEDICAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-231-2436
Mailing Address - Street 1:6835 RAVENCREST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1913
Mailing Address - Country:US
Mailing Address - Phone:719-231-2436
Mailing Address - Fax:
Practice Address - Street 1:4465 NORTHPARK DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4238
Practice Address - Country:US
Practice Address - Phone:719-231-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0019009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty