Healthcare Provider Details

I. General information

NPI: 1205752060
Provider Name (Legal Business Name): KNEADING NOMAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 ARLINGTON AVE
LOS ANGELES CA
90018-4316
US

IV. Provider business mailing address

3714 ARLINGTON AVE
LOS ANGELES CA
90018-4316
US

V. Phone/Fax

Practice location:
  • Phone: 240-472-0523
  • Fax:
Mailing address:
  • Phone: 240-472-0523
  • 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: MS. MELANIE NEWBY
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 240-472-0523