Provider Demographics
NPI:1306238324
Name:TREE OF LIFE MASSAGE AND WELLNESS LLC
Entity type:Organization
Organization Name:TREE OF LIFE MASSAGE AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-205-9910
Mailing Address - Street 1:5310 HOMESTEAD RD NE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1437
Mailing Address - Country:US
Mailing Address - Phone:505-205-9910
Mailing Address - Fax:
Practice Address - Street 1:5310 HOMESTEAD RD NE
Practice Address - Street 2:SUITE 202A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1437
Practice Address - Country:US
Practice Address - Phone:505-205-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty