Healthcare Provider Details

I. General information

NPI: 1609329044
Provider Name (Legal Business Name): HEALING PALM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BARDSTOWN RD SUITE 208
LOUISVILLE KY
40218-4605
US

IV. Provider business mailing address

3415 BARDSTOWN RD SUITE 208
LOUISVILLE KY
40218-4605
US

V. Phone/Fax

Practice location:
  • Phone: 502-422-0075
  • Fax:
Mailing address:
  • Phone: 502-422-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberKY-1156
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberKY1156
License Number StateKY

VIII. Authorized Official

Name: MRS. JANA P. SAINT LOUIS
Title or Position: OWNER/LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 502-422-0075