MEDICARE: RELAX REJUVENATE RESTORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1982567814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELAX REJUVENATE RESTORE

Provider Business Mailing Address
First Line	:	3358 DEL AIRE PL
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4806
Country	:	US
Telephone Number	:	405-882-7592
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 S AIR DEPOT BLVD STE D
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4810
Country	:	US
Telephone Number	:	405-882-7592
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	KENYA MONIQUE SHINE
Credential	:	LMT
Telephone Number	:	405-882-7204

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “RELAX REJUVENATE RESTORE ” Practice Location

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