Healthcare Provider Details

I. General information

NPI: 1669483491
Provider Name (Legal Business Name): FLOYDS KNOBS THERAPEUTIC MASSAGE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 PAOLI PIKE
FLOYDS KNOBS IN
47119-9751
US

IV. Provider business mailing address

3523 PAOLI PIKE
FLOYDS KNOBS IN
47119-9751
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-2799
  • Fax: 812-948-2769
Mailing address:
  • Phone: 812-948-2799
  • Fax: 812-948-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOHN LOI
Title or Position: PRESIDENT
Credential: NCTMB, CMT
Phone: 912-948-2799