1962625616 NPI number — NEURO MASSAGE THERAPIST, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962625616 NPI number — NEURO MASSAGE THERAPIST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEURO MASSAGE THERAPIST, INC
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:
1962625616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2295 NW CORPORATE BLVD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-7373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-241-1971
Provider Business Mailing Address Fax Number:
561-241-3969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 GLADES RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-7378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-416-1145
Provider Business Practice Location Address Fax Number:
561-416-2292
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SABELLA
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING DEPT
Authorized Official Telephone Number:
561-241-1971

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MM7938 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MM7938 . This is a "LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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