1467633172 NPI number — MASSAGE PROFESSIONALS, LLC

Table of content: (NPI 1467633172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467633172 NPI number — MASSAGE PROFESSIONALS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSAGE PROFESSIONALS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467633172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 7TH AVE
Provider Second Line Business Mailing Address:
SUITE 99
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-781-2253
Provider Business Mailing Address Fax Number:
304-781-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 99
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-781-2253
Provider Business Practice Location Address Fax Number:
304-781-2254
Provider Enumeration Date:
11/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-781-2253

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  2005-1679 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)