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General NPI Number Information
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NPI Number | 1164101275
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Entity Type | Organization
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Legal Business Name | LEAVE AT EASE MASSAGE
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 3234 CROWE DR
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City | NASHVILLE
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State | TN
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Zip | 37218-3104
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Country | US
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Telephone | 615-854-7434
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Fax |
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Provider Business Mailing Address
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Address Line | 3234 CROWE DR
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City | NASHVILLE
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State | TN
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Zip | 37218-3104
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Country | US
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Telephone | 629-215-0345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ALLEN BANKS
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Credential | LICENSED MT
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Telephone | 629-215-0345
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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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