Healthcare Provider Details

I. General information

NPI: 1447446745
Provider Name (Legal Business Name): THERAPEUTIC MASSAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 CALIFORNIA AVE
STUART FL
34994-2917
US

IV. Provider business mailing address

413 CALIFORNIA AVE
STUART FL
34994-2917
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-3095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA0004514
License Number StateFL

VIII. Authorized Official

Name: MS. MICHELLE L MCCRAIN
Title or Position: PRESIDENT
Credential: LMT
Phone: 772-288-3095