Pure Spa & Wellness

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT.0006794 Issued in CO

Legal business name

PURE SPA & WELLNESS

Practice address

279 S Purcell Blvd Ste 100
Pueblo West, CO 81007-5083

Phone

(719) 582-1432

NPI assigned

Mar 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tad Dorsey Childers, LCMT

Title

Medical Massage Therapist

Phone

(719) 582-1432

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457308800000",
    "number": "1285094011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 S PURCELL BLVD STE 100",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075083",
            "telephone_number": "719-582-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 S PURCELL BLVD STE 100",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075083",
            "telephone_number": "719-582-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE SPA & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2016-03-07",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "TAD",
        "authorized_official_middle_name": "DORSEY",
        "authorized_official_title_or_position": "MEDICAL MASSAGE THERAPIST",
        "authorized_official_telephone_number": "719-582-1432",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "CO",
            "license": "MT.0006794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Pueblo West, CO
• Providers in Pueblo West, CO by specialty
• Massage Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.