Healthcare Provider Details

I. General information

NPI: 1356245146
Provider Name (Legal Business Name): BLACK ONYX MOBILE MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7358 GARNERS FERRY RD STE 217
COLUMBIA SC
29209-2262
US

IV. Provider business mailing address

7358 GARNERS FERRY RD STE 217
COLUMBIA SC
29209-2262
US

V. Phone/Fax

Practice location:
  • Phone: 839-252-9337
  • Fax:
Mailing address:
  • Phone: 839-252-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SKYELAH FORD
Title or Position: CEO
Credential: LMT
Phone: 839-252-9337