Healthcare Provider Details

I. General information

NPI: 1780856070
Provider Name (Legal Business Name): MEDICAL MASSAGE OF DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W 17TH
WILMINGTON DE
19806
US

IV. Provider business mailing address

2309 W 17TH
WILMINGTON DE
19806
US

V. Phone/Fax

Practice location:
  • Phone: 302-571-9075
  • Fax: 970-204-6812
Mailing address:
  • Phone: 302-571-9075
  • Fax: 970-204-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberN/A
License Number StateCO

VIII. Authorized Official

Name: LINDA OGILVIE
Title or Position: OWNER
Credential: RN-CMT
Phone: 302-571-9075