Provider Demographics
NPI:1184804882
Name:REHABILITATIVE MASSAGE CLINIC, INC.
Entity type:Organization
Organization Name:REHABILITATIVE MASSAGE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DNH
Authorized Official - Phone:303-451-6706
Mailing Address - Street 1:7000 W 120TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2821
Mailing Address - Country:US
Mailing Address - Phone:303-451-6706
Mailing Address - Fax:303-451-6706
Practice Address - Street 1:7000 W 120TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2821
Practice Address - Country:US
Practice Address - Phone:303-451-6706
Practice Address - Fax:303-451-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service