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General NPI Number Information
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NPI Number | 1154120806
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Entity Type | Organization
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Legal Business Name | MIRACULOUS MASSAGE SERVICES LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 108 INVIEW RD STE 112
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-5234
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Country | US
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Telephone | 864-346-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 1168 LITTLE CEDAR CREEK RD
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City | WINNSBORO
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State | SC
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Zip | 29180-8916
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Country | US
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Telephone | 864-346-2877
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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 | MRS. SANQUINETTA NECOLE MILTON
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Credential |
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Telephone | 864-346-2877
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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 |
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License Number State |
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