Healthcare Provider Details

I. General information

NPI: 1285543991
Provider Name (Legal Business Name): FARMINGTON THERAPEUTIC MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W COLUMBIA ST
FARMINGTON MO
63640-1719
US

IV. Provider business mailing address

108 W COLUMBIA ST STE B
FARMINGTON MO
63640-1719
US

V. Phone/Fax

Practice location:
  • Phone: 573-516-0911
  • Fax:
Mailing address:
  • Phone: 573-516-0911
  • 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: MRS. SARAH MARIE WOMACK
Title or Position: OWNER
Credential: LMT
Phone: 641-590-5724