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General NPI Number Information
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NPI Number | 1164130639
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Entity Type | Organization
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Legal Business Name | SAGE OF THE LIGHT LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1798 ROOSEVELT TRAIL
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City | NAPLES
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State | ME
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Zip | 04055
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Country | US
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Telephone | 207-693-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 1798 ROOSEVELT TRAIL
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City | NAPLES
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State | ME
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Zip | 04055
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Country | US
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Telephone | 207-693-3240
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MR. GREGORY ALLEN PHILLIPS
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Credential | LMT
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Telephone | 207-693-3240
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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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