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General NPI Number Information
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NPI Number | 1225730278
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 03/21/2023
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 4873 MANHATTAN DR
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City | ROCKFORD
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State | IL
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Zip | 61108-2265
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Country | US
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Telephone | 815-977-5876
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Fax | 855-509-0419
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Provider Business Mailing Address
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Address Line | 4873 MANHATTAN DR
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City | ROCKFORD
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State | IL
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Zip | 61108-2265
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Country | US
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Telephone | 815-977-5876
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Fax | 855-509-0419
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTY A CELLITTI
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Credential | LMT
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Telephone | 815-977-5876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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