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General NPI Number Information
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NPI Number | 1063953925
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Entity Type | Organization
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Legal Business Name | UNIQUE FITNESS
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Dates
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Enumeration Date | 03/12/2017
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Last Update Date | 03/12/2017
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Provider Practice Location Address
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Address Line | 263 QUAKER LN
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City | WEST WARWICK
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State | RI
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Zip | 02893-2122
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Country | US
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Telephone | 401-615-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 263 QUAKER LN
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City | WEST WARWICK
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State | RI
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Zip | 02893-2122
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Country | US
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Telephone | 401-615-2355
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Fax |
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Authorized Official
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Title or Position | OWNER, MASSAGE THERAPIST
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Name | MRS. CLAUDIA BOTTHOF
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Credential | MS, LMT
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Telephone | 402-822-2561
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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 | MT02245
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License Number State | RI
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