Provider Demographics
NPI:1316308422
Name:MAE MASSAGE
Entity type:Organization
Organization Name:MAE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:720-839-8937
Mailing Address - Street 1:15211 E 101ST WAY
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9741
Mailing Address - Country:US
Mailing Address - Phone:720-839-8937
Mailing Address - Fax:
Practice Address - Street 1:15211 E 101ST WAY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9741
Practice Address - Country:US
Practice Address - Phone:720-839-8937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013383173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty