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General NPI Number Information
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NPI Number | 1184092850
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Entity Type | Organization
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Legal Business Name | HEALING RIVERS THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 728 CHESTNUT STREET SUITE 7
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City | BOWLING GREEN
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State | KY
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Zip | 42101
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Country | US
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Telephone | 270-331-3915
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Fax |
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Provider Business Mailing Address
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Address Line | 890 FAIRVIEW AVE APARTMENT D112
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4962
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Country | US
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Telephone | 270-331-3915
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Fax |
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Authorized Official
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Title or Position | OWNER/LMT
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Name | ANGELA ESPANA
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Credential | LMT
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Telephone | 270-331-3915
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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 | 4371
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License Number State | KY
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