Provider Demographics
NPI:1912456518
Name:THE POTTER'S HANDS MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:THE POTTER'S HANDS MASSAGE THERAPY, LLC
Other - Org Name:THE POTTER'S HANDS MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-930-4504
Mailing Address - Street 1:3585 DARKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1611
Mailing Address - Country:US
Mailing Address - Phone:719-930-4504
Mailing Address - Fax:
Practice Address - Street 1:3585 DARKWOOD PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1611
Practice Address - Country:US
Practice Address - Phone:719-930-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012377225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty