=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043092877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IT'S ALL ABOUT YOU CORPORATE CHAIR AND TABLE MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2023
-----------------------------------------------------
Last Update Date | 04/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2955 COBB PKWY SE STE 301
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-294-1187
-----------------------------------------------------
Fax | 562-684-0621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 91708
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90009-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-284-5444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WANDAH KAY-JOHNSON
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 818-284-5444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------