| NPI | 1558089904 |
|---|---|
| Former Legal Business Name | MOUNTAIN STATE MEDICAL MASSAGE |
| Entity Type | Organization |
| Authorized Contact | JENNY M NICKERSON Owner 720-841-1042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2023-01-18 |