Organization
PUEBLO MASSAGE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY WALKER NICHOLLS LAC (MANAGING MEMBER)
(719) 396-5375
Entity
Organization
Contact information
Practice address
1401 FORTINO BLVD STE B, PUEBLO, CO 81008-2034
(719) 582-9446
Mailing address
PO BOX 296, BEULAH, CO 81023-0296
(719) 582-9446
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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