Provider Demographics
NPI:1740423987
Name:COLORADO MASSAGE CENTER
Entity Type:Organization
Organization Name:COLORADO MASSAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RMT
Authorized Official - Phone:303-443-5202
Mailing Address - Street 1:3109 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1315
Mailing Address - Country:US
Mailing Address - Phone:303-443-5202
Mailing Address - Fax:303-440-8897
Practice Address - Street 1:3109 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1315
Practice Address - Country:US
Practice Address - Phone:303-443-5202
Practice Address - Fax:303-440-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty