Organization · Type 2 NPI

Mountain State Medical Massage

Massage Therapist · Centennial, CO

NPI number 1558089904 Active

Practice location

6970 S Holly Cir
Centennial, CO 80112-6296

Call (720) 841-1042 Map

Mailing address

4767 S Odessa St
Centennial, CO 80015-3449

Specialties and licenses

Taxonomy	Code	License
Massage Therapist Primary	225700000X	None listed

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

3 other providers at this address

Other massage therapist providers in Centennial

See all in Centennial →

NPI record

NPI: 1558089904
Entity type: Organization (Type 2)
Issued: Aug 19, 2022
Last updated: Jan 18, 2023
Status: Active

Other names

<unavail>
Mountain State Medical Massage · doing business as
Mountain State Medical Massage · former legal business name
Mountain State Medical Massage · former legal business name

Authorized official

Jenny M Nickerson, LMT
Owner
(720) 841-1042

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1558089904

Mountain State Medical Massage's National Provider Identifier is 1558089904, issued on Aug 19, 2022. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Centennial, CO. The record was last updated on Jan 18, 2023.