Healthcare Provider Details

I. General information

NPI: 1194342931
Provider Name (Legal Business Name): FULL CIRCLE MASSAGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 BREVARD RD STE 105
HORSE SHOE NC
28742-8809
US

IV. Provider business mailing address

3754 BREVARD RD STE 105
HORSE SHOE NC
28742-8809
US

V. Phone/Fax

Practice location:
  • Phone: 828-606-0258
  • Fax:
Mailing address:
  • Phone: 828-606-0258
  • 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: TINA BENNETT PENLAND
Title or Position: OWNER
Credential: LMBT, BCTMB
Phone: 828-606-0258