Pueblo Massage Therapy LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

PUEBLO MASSAGE THERAPY LLC

Practice address

1401 Fortino Blvd Ste B
Pueblo, CO 81008-2034

Phone

(719) 582-9446

NPI assigned

Jun 15, 2021

Last updated

Jun 15, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracey Walker Nicholls, LAC

Title

Managing Member

Phone

(719) 396-5375

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1992373021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "BEULAH",
            "state": "CO",
            "postal_code": "810230296",
            "telephone_number": "719-582-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 FORTINO BLVD STE B",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082034",
            "telephone_number": "719-582-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO MASSAGE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "WALKER NICHOLLS",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "719-396-5375",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pueblomassagetherapy@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "email",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "any",
            "address_1": "1401 Fortino Blvd Ste B",
            "city": "Pueblo",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810082034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.