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General NPI Number Information
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NPI Number | 1225304306
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Entity Type | Organization
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Legal Business Name | A TOUCH OF PARADISE MASSAGE CENTER
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 366 WALLER AVE STE 109
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City | LEXINGTON
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State | KY
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Zip | 40504-2920
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Country | US
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Telephone | 859-381-9503
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Fax | 859-309-1808
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Provider Business Mailing Address
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Address Line | 366 WALLER AVE STE 109
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City | LEXINGTON
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State | KY
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Zip | 40504-2920
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Country | US
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Telephone | 859-381-9503
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Fax | 859-309-1808
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Authorized Official
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Title or Position | OWNER
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Name | ERIC JOHN BYRD
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Credential | LMT
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Telephone | 859-338-4634
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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 | KY-2031
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License Number State | KY
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