Provider Demographics
NPI:1962855585
Name:FORT COLLINS MEDICAL MASSAGE
Entity Type:Organization
Organization Name:FORT COLLINS MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TWYLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:OSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-227-7274
Mailing Address - Street 1:2021 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1307
Mailing Address - Country:US
Mailing Address - Phone:970-227-7274
Mailing Address - Fax:970-286-2424
Practice Address - Street 1:3938 JOHN F KENNEDY PKWY
Practice Address - Street 2:SUITE 11-F
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3086
Practice Address - Country:US
Practice Address - Phone:970-286-2723
Practice Address - Fax:970-286-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2015153590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty