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General NPI Number Information
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NPI Number | 1245919968
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Entity Type | Organization
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Legal Business Name | CHA'LIQUE MEDICAL MASSAGE SPA
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 3964 GOODMAN RD E STE 122
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City | SOUTHAVEN
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State | MS
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Zip | 38672-8709
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Country | US
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Telephone | 901-283-8290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 154
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0002
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Country | US
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Telephone | 901-283-8290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHALONDAS REED-PHILLIPS
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Credential |
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Telephone | 901-283-8290
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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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