Basic Information
| Provider Information | |||||||||
| NPI: | 1285996728 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KAASA | ||||||||
| FirstName: | AZALEA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | RMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9160 E ARBOR CIR | ||||||||
| Address2: | UNIT H | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801115249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202198658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8725 WADSWORTH BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800030928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034257298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 12680 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.