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General NPI Number Information
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NPI Number | 1245413509
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Entity Type | Organization
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Legal Business Name | MASSAGE THERAPY WORX
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 728 GOODMAN RD E STE 3
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9530
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Country | US
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Telephone | 662-536-2220
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Fax | 662-536-2221
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Provider Business Mailing Address
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Address Line | 728 GOODMAN RD E STE 3
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9530
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Country | US
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Telephone | 662-536-2220
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Fax | 662-536-2221
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. DEBRA K DISNEY
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Credential | RMT,LMT,NCTMB
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Telephone | 662-536-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1021
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License Number State | MS
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