Healthcare Provider Details

I. General information

NPI: 1467633172
Provider Name (Legal Business Name): MASSAGE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 7TH AVE SUITE 99
HUNTINGTON WV
25701-2131
US

IV. Provider business mailing address

611 7TH AVE SUITE 99
HUNTINGTON WV
25701-2131
US

V. Phone/Fax

Practice location:
  • Phone: 304-781-2253
  • Fax: 304-781-2254
Mailing address:
  • Phone: 304-781-2253
  • Fax: 304-781-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2005-1679
License Number StateWV

VIII. Authorized Official

Name: MRS. SHEILA JO WILLIAMS
Title or Position: OWNER
Credential: LMT
Phone: 304-781-2253