1962766535 NPI number — MEDICAL MASSAGE PROFESSIONALS LLC

Table of content: (NPI 1962766535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962766535 NPI number — MEDICAL MASSAGE PROFESSIONALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL 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:
MY TRAVELING THERAPIST INC
Provider Other Organization Name Type Code:
4
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:
1962766535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8705 COLESVILLE RD
Provider Second Line Business Mailing Address:
SUITE B-198
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-506-7470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8705 COLESVILLE RD
Provider Second Line Business Practice Location Address:
SUITE B-198
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-506-7470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ESCOFFERY
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
240-506-7470

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  R01540 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0019009926 . This is a "MASSAGE THERAPY LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 603891-11 . This is a "NCBTMB BOARD CERTIFICATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MT1603 . This is a "MASSAGE THERAPY LICENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: M05500 . This is a "MASSAGE THERAPY LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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