=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013332675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY HEALTH MASSOTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2014
-----------------------------------------------------
Last Update Date | 05/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2718 SUNSET BLVD SUITE D
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-317-2219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2718 SUNSET BLVD SUITE D
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-317-2219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELISSA ANTOINETTE RYAN
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 740-317-2219
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 33014123
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------