Provider Demographics
NPI:1861826232
Name:MOUNTAIN SAGE MASSAGE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN SAGE MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:970-445-8137
Mailing Address - Street 1:7019 S KNOLLS WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1732
Mailing Address - Country:US
Mailing Address - Phone:970-445-8137
Mailing Address - Fax:
Practice Address - Street 1:7019 S KNOLLS WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1732
Practice Address - Country:US
Practice Address - Phone:970-445-8137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty