=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093654915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASSAGE RADIANT & MOBILE MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 WORTHINGTON ACCESS DR SUITE 27
-----------------------------------------------------
City | MARYLAND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63043
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WORTHINGTON ACCESS DR SUITE 27
-----------------------------------------------------
City | MARYLAND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63043
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERIC WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-496-3774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------