Organization
GLENDALE SPORTS MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EAGLE BOWERS BA, CFT,LMT (OWNER)
(623) 215-2525
Entity
Organization
Contact information
Practice address
6808 N DYSART RD, #136, GLENDALE, AZ 85307-2231
(623) 215-2525
Mailing address
6808 N DYSART RD, #136, GLENDALE, AZ 85307-2231
(623) 215-2525
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/07/2011
Last updated
11/30/2011
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