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General NPI Number Information
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NPI Number | 1205231420
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Entity Type | Organization
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Legal Business Name | ALLAY INTEGRATIVE MASSAGE THERAPY CENTER LLC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 2543 ROSS CLARK CIR SUITE #4
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City | DOTHAN
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State | AL
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Zip | 36301-4925
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Country | US
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Telephone | 334-701-9332
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Fax | 334-699-1308
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Provider Business Mailing Address
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Address Line | 2543 ROSS CLARK CIR SUITE #4
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City | DOTHAN
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State | AL
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Zip | 36301-4925
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Country | US
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Telephone | 334-701-9332
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Fax | 334-699-1308
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Authorized Official
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Title or Position | OWNER/LMT
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Name | MRS. JANA NADINE COOPER
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Credential | LMT
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Telephone | 334-701-9332
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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 | 2235
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License Number State | AL
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