Provider Demographics
NPI:1457004384
Name:STAR MASSAGE, LLC
Entity type:Organization
Organization Name:STAR MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:515-897-8824
Mailing Address - Street 1:44 E SPAULDING AVE
Mailing Address - Street 2:BLD 3, STE 3
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007
Mailing Address - Country:US
Mailing Address - Phone:515-897-8824
Mailing Address - Fax:
Practice Address - Street 1:44 E SPAULDING AVE
Practice Address - Street 2:BLD 3, STE 3
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:515-897-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty