Provider Demographics
NPI:1285996728
Name:KAASA, AZALEA GRACE (RMT)
Entity type:Individual
Prefix:
First Name:AZALEA
Middle Name:GRACE
Last Name:KAASA
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 E ARBOR CIR
Mailing Address - Street 2:UNIT H
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5249
Mailing Address - Country:US
Mailing Address - Phone:720-219-8658
Mailing Address - Fax:
Practice Address - Street 1:8725 WADSWORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0928
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist