Provider Demographics
NPI:1356799431
Name:THERAPEUTIC MASSAGE FROM TETYANA
Entity type:Organization
Organization Name:THERAPEUTIC MASSAGE FROM TETYANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TETYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GNATYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-366-1661
Mailing Address - Street 1:19630 CLUBHOUSE DR APT 232
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-6201
Mailing Address - Country:US
Mailing Address - Phone:720-366-1661
Mailing Address - Fax:
Practice Address - Street 1:12919 STROH RANCH CT UNIT B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7707
Practice Address - Country:US
Practice Address - Phone:720-366-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014452174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty