Healthcare Provider Details

I. General information

NPI: 1780975987
Provider Name (Legal Business Name): HEALTH YOURSELF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 CARROLLTON AVE
INDIANAPOLIS IN
46280-1725
US

IV. Provider business mailing address

3934 W 96TH ST SUITE A
INDIANAPOLIS IN
46268-2927
US

V. Phone/Fax

Practice location:
  • Phone: 317-379-6007
  • Fax:
Mailing address:
  • Phone: 317-379-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT21003333
License Number StateIN

VIII. Authorized Official

Name: DAINAH RENAE CRAFT
Title or Position: OWNER
Credential:
Phone: 317-379-6007