Provider Demographics
NPI:1730655077
Name:KNEADING SOULSTICE MASSAGE LLC
Entity Type:Organization
Organization Name:KNEADING SOULSTICE MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:OHARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CNMT
Authorized Official - Phone:719-352-9584
Mailing Address - Street 1:495 ANACONDA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2044
Mailing Address - Country:US
Mailing Address - Phone:719-352-9584
Mailing Address - Fax:
Practice Address - Street 1:495 ANACONDA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2044
Practice Address - Country:US
Practice Address - Phone:719-352-9584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty