Healthcare Provider Details

I. General information

NPI: 1396335733
Provider Name (Legal Business Name): MASSAGE WORX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W HIGHWAY 62
FARMINGTON AR
72730-9560
US

IV. Provider business mailing address

12200 W HIGHWAY 62
FARMINGTON AR
72730-9560
US

V. Phone/Fax

Practice location:
  • Phone: 239-293-5477
  • Fax:
Mailing address:
  • Phone: 239-293-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WING
Title or Position: LMT
Credential: LMT
Phone: 239-293-5477