1225350127 NPI number — CENTER FOR THERAPEUTIC MASSAGE

Table of content: (NPI 1225350127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225350127 NPI number — CENTER FOR THERAPEUTIC MASSAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR THERAPEUTIC MASSAGE
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:
1225350127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1064 GARDNER RD
Provider Second Line Business Mailing Address:
SUITE 1064
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29407-5768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-852-9939
Provider Business Mailing Address Fax Number:
843-852-9949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 COURTENAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29401-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-852-9939
Provider Business Practice Location Address Fax Number:
843-852-9949
Provider Enumeration Date:
02/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITH
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER, MASSAGE THERAPIST
Authorized Official Telephone Number:
843-852-9939

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  5437 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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