Organization
EMBODY CO-OP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHON BRANDON STAKELY CMT (MASSAGE THERAPIST)
(719) 505-5174
Entity
Organization
Contact information
Practice address
2860 S CIRCLE DR STE 250I, COLORADO SPRINGS, CO 80906-4113
(719) 505-5174
Mailing address
2860 S CIRCLE DR STE 250I, COLORADO SPRINGS, CO 80906-4113
(719) 505-5174
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/22/2024
Last updated
10/22/2024
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