| NPI | 1952933343 |
|---|---|
| Former Legal Business Name | REVIVE MASSAGE |
| Entity Type | Organization |
| Authorized Contact | SHAYLA JOHNSON Owner/Operator 970-443-5645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-02-04 |