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General NPI Number Information
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NPI Number | 1073865234
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Entity Type | Organization
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Legal Business Name | MASSAGE THERAPY CENTERS OF AMERICA, INC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 747 NORTH LASALLE DR 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-854-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 747 NORTH LASALLE DR 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-854-2834
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMMANUEL BISTAS
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Credential | LMT, MBA
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Telephone | 312-854-2834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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