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General NPI Number Information
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NPI Number | 1043556236
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Entity Type | Organization
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Legal Business Name | ISABELL & EVE THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 1650 HALLIE RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-6521
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Country | US
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Telephone | 715-382-3392
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Fax |
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Provider Business Mailing Address
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Address Line | 14959 205TH ST
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City | JIM FALLS
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State | WI
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Zip | 54748-1822
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Country | US
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Telephone | 715-382-3392
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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 | MS. SUMMER ASHLYN PENA-OLSON
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Credential | LMT
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Telephone | 715-382-3392
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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 | 10834-146
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License Number State | WI
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