Healthcare Provider Details

I. General information

NPI: 1801271861
Provider Name (Legal Business Name): INFORMED TOUCH MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 IBIZA CT
TOWNSEND DE
19734-3052
US

IV. Provider business mailing address

905 IBIZA CT
TOWNSEND DE
19734-3052
US

V. Phone/Fax

Practice location:
  • Phone: 302-229-8239
  • Fax:
Mailing address:
  • Phone: 302-229-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberMT-0002666
License Number StateDE

VIII. Authorized Official

Name: MS. JODI LYNN COLLINS
Title or Position: OWNER/OPERATOR
Credential: LMT, C-PT
Phone: 302-229-8239