Healthcare Provider Details

I. General information

NPI: 1528208360
Provider Name (Legal Business Name): NALANI'S MEDICAL & SPA MASSAGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 E MITCHELL AVE
CINCINNATI OH
45229-1416
US

IV. Provider business mailing address

848 E MITCHELL AVE
CINCINNATI OH
45229-1416
US

V. Phone/Fax

Practice location:
  • Phone: 937-212-4771
  • Fax:
Mailing address:
  • Phone: 513-205-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number33.016252
License Number StateOH

VIII. Authorized Official

Name: MISS NICOLE MARIE JACKSON
Title or Position: PRESIDENT
Credential: LMT
Phone: 513-205-7597