Healthcare Provider Details

I. General information

NPI: 1528421591
Provider Name (Legal Business Name): NMN MASSAGE & BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E SUNSHINE ST STE 102
SPRINGFIELD MO
65807-2661
US

IV. Provider business mailing address

1019 W MEADOWMERE ST
SPRINGFIELD MO
65807-1334
US

V. Phone/Fax

Practice location:
  • Phone: 417-872-8422
  • Fax:
Mailing address:
  • Phone: 417-872-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number707742
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number707742
License Number StateMO

VIII. Authorized Official

Name: NGOC MINH TA NGUYEN
Title or Position: LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 417-872-8422