Healthcare Provider Details

I. General information

NPI: 1629585617
Provider Name (Legal Business Name): LIVE NOW BREATHE MASSAGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 8TH ST
NOBLESVILLE IN
46060-2714
US

IV. Provider business mailing address

PO BOX 945
NOBLESVILLE IN
46061-0945
US

V. Phone/Fax

Practice location:
  • Phone: 317-654-4255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDSAY BALES
Title or Position: OWNER
Credential: LMT
Phone: 317-654-4255