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General NPI Number Information
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NPI Number | 1184081226
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Entity Type | Organization
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Legal Business Name | LIVING WELL THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 1219 BYPASS 72 NE 1219 BYPASS 72
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City | GREENWOOD
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State | SC
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Zip | 29649-2263
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Country | US
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Telephone | 864-923-1661
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Fax | 864-923-1661
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Provider Business Mailing Address
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Address Line | PO BOX 325 4
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City | CLINTON
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State | SC
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Zip | 29325-0325
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Country | US
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Telephone | 864-923-1661
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Fax | 864-923-1661
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA L TOLAND
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Credential | LMT
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Telephone | 864-923-1661
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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 | 9777
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License Number State | SC
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