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General NPI Number Information
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NPI Number | 1215558556
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Entity Type | Organization
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Legal Business Name | MARYVILLE MASSAGE
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 1056 WILLOW CREEK CIR
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City | MARYVILLE
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State | TN
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Zip | 37804-3569
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Country | US
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Telephone | 865-801-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 1056 WILLOW CREEK CIR
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City | MARYVILLE
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State | TN
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Zip | 37804-3569
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Country | US
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Telephone | 865-801-5551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE KIM BARR
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Credential | LMT
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Telephone | 865-801-5551
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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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