Provider Demographics
NPI:1457740276
Name:BRIGHT STARR THERAPUETIC MASSAGE LLC
Entity Type:Organization
Organization Name:BRIGHT STARR THERAPUETIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VERMILLION-HORN
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:720-878-1236
Mailing Address - Street 1:26291 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-8500
Mailing Address - Country:US
Mailing Address - Phone:720-878-1236
Mailing Address - Fax:
Practice Address - Street 1:26291 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-8500
Practice Address - Country:US
Practice Address - Phone:720-878-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHT STARR THERAPEUTIC MASSAGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-16
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty