Provider Demographics
NPI:1861074080
Name:POLARIS THERAPEUTIC MASSAGE & BODYWORK
Entity type:Organization
Organization Name:POLARIS THERAPEUTIC MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:915-300-0272
Mailing Address - Street 1:1204 MONTANA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5512
Mailing Address - Country:US
Mailing Address - Phone:915-300-0272
Mailing Address - Fax:
Practice Address - Street 1:1204 MONTANA AVE STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5512
Practice Address - Country:US
Practice Address - Phone:915-300-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty