Provider Demographics
NPI:1710294624
Name:SULLIVAN MASSAGE THERAPY
Entity Type:Organization
Organization Name:SULLIVAN MASSAGE THERAPY
Other - Org Name:SMT INTEGRATIVE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:RMT, NCTMB
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-736-6227
Mailing Address - Street 1:6726 S REVERE PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3961
Mailing Address - Country:US
Mailing Address - Phone:303-736-6227
Mailing Address - Fax:303-736-6244
Practice Address - Street 1:6726 S REVERE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3961
Practice Address - Country:US
Practice Address - Phone:303-736-6227
Practice Address - Fax:303-736-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740504406OtherNPI