Healthcare Provider Details

I. General information

NPI: 1245441799
Provider Name (Legal Business Name): ESCAPE THERAPEUTIC MASSAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BAYOU BLVD SUITE 24
PENSACOLA FL
32503-2673
US

IV. Provider business mailing address

4400 BAYOU BLVD SUITE 24
PENSACOLA FL
32503-2673
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-2273
  • Fax: 850-475-1687
Mailing address:
  • Phone: 850-478-2273
  • Fax: 850-475-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM19321
License Number StateFL

VIII. Authorized Official

Name: MISS STEPHANIE ELIZABETH KNIGHT
Title or Position: OWNER
Credential: LMT
Phone: 850-478-2273