Provider Demographics
NPI:1457108573
Name:MOUNTAIN VALLEY MASSAGE
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:970-424-7963
Mailing Address - Street 1:5314 OSBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2690
Mailing Address - Country:US
Mailing Address - Phone:970-424-7963
Mailing Address - Fax:
Practice Address - Street 1:5314 OSBOURNE DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-2690
Practice Address - Country:US
Practice Address - Phone:970-424-7963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty