Organization
BROOKESIDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE NICHOLE FOLTZ LMT (OWNER/MASSAGE THERAPIST)
(971) 273-9432
Entity
Organization
Contact information
Practice address
80 ACOMA BLVD S STE 104&106, LAKE HAVASU CITY, AZ 86403-6925
(928) 453-1055
Mailing address
2827 SARATOGA AVE, LAKE HAVASU CITY, AZ 86406-6956
(971) 273-9432
(928) 224-1775
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326770363
—
AZ
Enumeration date
12/04/2023
Last updated
12/04/2023
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