Provider Demographics
NPI:1063984409
Name:THIS IS MASSAGE
Entity type:Organization
Organization Name:THIS IS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:MOISES
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:720-551-1520
Mailing Address - Street 1:2625 W 133RD CIRCLE DR.
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD CO
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:720-551-1520
Mailing Address - Fax:
Practice Address - Street 1:2625 W 133RD CIRCLE DR.
Practice Address - Street 2:
Practice Address - City:BROOMFIELD CO
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:720-551-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Single Specialty