Provider Demographics
NPI:1093532293
Name:SUN WOMAN MASSAGE LLC
Entity type:Organization
Organization Name:SUN WOMAN MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-855-8618
Mailing Address - Street 1:2037 JERRY MURPHY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1256
Mailing Address - Country:US
Mailing Address - Phone:719-664-6839
Mailing Address - Fax:
Practice Address - Street 1:2037 JERRY MURPHY RD STE 101
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1256
Practice Address - Country:US
Practice Address - Phone:719-664-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty