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General NPI Number Information
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NPI Number | 1144423047
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ARTS OF MASSAGE & BODYWORK LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13026 W RANCHO SANTA FE BLVD B100
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 623-935-7900
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Fax | 623-935-7905
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Provider Business Mailing Address
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Address Line | 13026 W RANCHO SANTA FE BLVD B100
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 623-935-7900
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Fax | 623-935-7905
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Authorized Official
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Title or Position | OWNER
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Name | MR. LESLIE L JOHNSON II
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Credential | LMT
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Telephone | 623-628-3279
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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 | MT07261
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License Number State | AZ
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