Provider Demographics
NPI:1013128388
Name:PEACEFUL SPIRIT THERAPEUTIC MASSAGE CENTERS LLC
Entity Type:Organization
Organization Name:PEACEFUL SPIRIT THERAPEUTIC MASSAGE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCORDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-320-1953
Mailing Address - Street 1:2930 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1912
Mailing Address - Country:US
Mailing Address - Phone:520-320-1953
Mailing Address - Fax:
Practice Address - Street 1:2930 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1912
Practice Address - Country:US
Practice Address - Phone:520-320-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty