Provider Demographics
NPI:1366787533
Name:GLASS & GLASS BODYWORK, LLC
Entity type:Organization
Organization Name:GLASS & GLASS BODYWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:COURTENAY
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:IV
Authorized Official - Credentials:RMT, NCMT
Authorized Official - Phone:970-403-5453
Mailing Address - Street 1:24 SUNRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5868
Mailing Address - Country:US
Mailing Address - Phone:970-403-5453
Mailing Address - Fax:
Practice Address - Street 1:801 FLORIDA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4780
Practice Address - Country:US
Practice Address - Phone:970-403-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty