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General NPI Number Information
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NPI Number | 1174231260
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Entity Type | Organization
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Legal Business Name | REVIVING TOUCH CORRECTIVE MASSAGE, LLC
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 2211 RACE ST
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City | JONESBORO
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State | AR
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Zip | 72401-7218
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Country | US
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Telephone | 870-810-8902
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Fax | 870-345-7009
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Provider Business Mailing Address
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Address Line | 3624 RED MAPLE WAY
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City | JONESBORO
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State | AR
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Zip | 72404-5041
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Country | US
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Telephone | 870-810-8902
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Fax | 870-345-7009
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. PATTI B OGDEN
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Credential |
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Telephone | 815-222-2042
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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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