Provider Demographics
NPI:1184099160
Name:MASSAGE BLISS
Entity type:Organization
Organization Name:MASSAGE BLISS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:970-222-1379
Mailing Address - Street 1:1020 WABASH ST
Mailing Address - Street 2:#11-203
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3191
Mailing Address - Country:US
Mailing Address - Phone:970-222-1379
Mailing Address - Fax:
Practice Address - Street 1:4730 S COLLEGE AVE
Practice Address - Street 2:STE #103
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3700
Practice Address - Country:US
Practice Address - Phone:970-222-1379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSAGE BLISS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty