Provider Demographics
NPI:1821859638
Name:COMPASS BLOOM MASSAGE LLC
Entity Type:Organization
Organization Name:COMPASS BLOOM MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KANIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:210-463-0361
Mailing Address - Street 1:100 E SAINT VRAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4941
Mailing Address - Country:US
Mailing Address - Phone:210-463-0361
Mailing Address - Fax:
Practice Address - Street 1:100 E SAINT VRAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4941
Practice Address - Country:US
Practice Address - Phone:210-463-0361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty