Provider Demographics
NPI:1932227576
Name:COLORADO MEDICAL MASSAGE AND INJURY CLINIC
Entity Type:Organization
Organization Name:COLORADO MEDICAL MASSAGE AND INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-532-9900
Mailing Address - Street 1:7824 N ACADEMY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3961
Mailing Address - Country:US
Mailing Address - Phone:719-532-9900
Mailing Address - Fax:719-532-0023
Practice Address - Street 1:7824 N ACADEMY BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3961
Practice Address - Country:US
Practice Address - Phone:719-532-9900
Practice Address - Fax:719-532-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty