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General NPI Number Information
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NPI Number | 1184378218
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MOBILE MASSAGE LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 1046 OLD SEWANEE RD
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City | SEWANEE
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State | TN
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Zip | 37375-6041
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Country | US
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Telephone | 908-328-8769
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Fax |
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Provider Business Mailing Address
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Address Line | 706 OLD SEWANEE RD
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City | SEWANEE
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State | TN
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Zip | 37375-6024
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Country | US
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Telephone | 908-328-8769
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. LAUREN LAURINO
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Credential | LMT
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Telephone | 908-328-8769
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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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