Provider Demographics
NPI:1730474255
Name:CENTER FOR NEUROMUSCULAR MASSAGE THERAPY
Entity Type:Organization
Organization Name:CENTER FOR NEUROMUSCULAR MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:ILIEVA
Authorized Official - Last Name:PASKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LMT
Authorized Official - Phone:303-777-1151
Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5033
Mailing Address - Country:US
Mailing Address - Phone:303-777-1151
Mailing Address - Fax:303-777-3112
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5033
Practice Address - Country:US
Practice Address - Phone:303-777-1151
Practice Address - Fax:303-777-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12963174400000X
CO6745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty