1184804882 NPI number — REHABILITATIVE MASSAGE CLINIC, INC.

Table of content: YARENI DE ANDA DRAKE LMSW (NPI 1104472398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184804882 NPI number — REHABILITATIVE MASSAGE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATIVE MASSAGE CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184804882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 W 120TH AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80020-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-451-6706
Provider Business Mailing Address Fax Number:
303-451-6706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 W 120TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BROOMFIELD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80020-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-451-6706
Provider Business Practice Location Address Fax Number:
303-451-6706
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NOELLE
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-451-6706

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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