Healthcare Provider Details

I. General information

NPI: 1285556019
Provider Name (Legal Business Name): REFINED RECOVERY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N FREDERICK ST # 2201
CAPE GIRARDEAU MO
63701-9998
US

IV. Provider business mailing address

320 N FREDERICK ST # 2201
CAPE GIRARDEAU MO
63701-9998
US

V. Phone/Fax

Practice location:
  • Phone: 804-807-2278
  • Fax:
Mailing address:
  • Phone: 804-807-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number
License Number State

VIII. Authorized Official

Name: TIYANA THOMAS
Title or Position: NURSING SUPERVISOR
Credential: RN
Phone: 804-807-2278