Provider Demographics
NPI:1861870347
Name:STANDLEY LAKE MASSAGE
Entity type:Organization
Organization Name:STANDLEY LAKE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-333-1589
Mailing Address - Street 1:8725 WADSWORTH BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-0928
Mailing Address - Country:US
Mailing Address - Phone:303-425-7298
Mailing Address - Fax:
Practice Address - Street 1:8725 WADSWORTH BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0928
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0013340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center