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General NPI Number Information
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NPI Number | 1033527692
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC CONNECTION MASSAGE & WELLNESS SPA
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 801 MASTER ST SUITE #3
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City | CORBIN
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State | KY
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Zip | 40701-1026
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Country | US
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Telephone | 606-261-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 801 MASTER ST SUITE #3
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City | CORBIN
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State | KY
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Zip | 40701-1026
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Country | US
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Telephone | 606-261-2050
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. JOY I TUSSEY
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Credential | LMT
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Telephone | 606-261-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | KY5196
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License Number State | KY
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