Provider Demographics
NPI:1346495066
Name:CELESTIAL PYRAMID MASSAGETHERAPY LLC
Entity type:Organization
Organization Name:CELESTIAL PYRAMID MASSAGETHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-296-2887
Mailing Address - Street 1:9809 CANDELARIA RD NE STE 2B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1459
Mailing Address - Country:US
Mailing Address - Phone:505-296-2887
Mailing Address - Fax:
Practice Address - Street 1:9809 CANDELARIA RD NE STE 2B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1459
Practice Address - Country:US
Practice Address - Phone:505-296-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty