Provider Demographics
NPI:1851664213
Name:ADVANCED THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:ADVANCED THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROISUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-335-1118
Mailing Address - Street 1:1701 KIPLING ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2848
Mailing Address - Country:US
Mailing Address - Phone:720-335-1118
Mailing Address - Fax:303-238-5553
Practice Address - Street 1:1701 KIPLING ST STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2848
Practice Address - Country:US
Practice Address - Phone:720-335-1118
Practice Address - Fax:303-238-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty