Provider Demographics
NPI: | 1952784563 |
---|---|
Name: | REDEFINE RELIEF, LLC |
Entity Type: | Organization |
Organization Name: | REDEFINE RELIEF, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHANNON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GLORIOSO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMT |
Authorized Official - Phone: | 312-351-5245 |
Mailing Address - Street 1: | PO BOX 352076 |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTMINSTER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80035-2076 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11859 PECOS ST |
Practice Address - Street 2: | |
Practice Address - City: | WESTMINSTER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80234-2741 |
Practice Address - Country: | US |
Practice Address - Phone: | 312-351-5245 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-06-30 |
Last Update Date: | 2015-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 15496 | 225700000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Single Specialty |