GLENDALE SPORTS MASSAGE LLC NPI 1730463852

NPI Information

GLENDALE SPORTS MASSAGE LLC is a massage therapist in Glendale, AZ. The provider is 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. GLENDALE SPORTS MASSAGE LLC NPI is 1730463852. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6808 N DYSART RD
#136
GLENDALE, AZ
ZIP 85307-231
Phone: (623) 215-2525

The provider's authorized official is Eagle Bowers .
The authorized official title is Owner and has the following contact phone number (623) 215-2525.

The CLIA number assigned to this NPI record is 03D2136742 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/7/2011 and was last updated on 11/30/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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