Healthcare Provider Details

I. General information

NPI: 1154241222
Provider Name (Legal Business Name): LUXE HOLISTIC MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 US 42
FLORENCE KY
41042-1901
US

IV. Provider business mailing address

7211 US 42
FLORENCE KY
41042-1901
US

V. Phone/Fax

Practice location:
  • Phone: 859-486-4075
  • Fax:
Mailing address:
  • Phone: 859-486-4075
  • 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: JESSICA DAWN JOHNSON
Title or Position: OWNER
Credential: LMT
Phone: 859-486-4075