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General NPI Number Information
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NPI Number | 1255652228
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Entity Type | Organization
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Legal Business Name | ZEN WELLNESS
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 6111 HARRISON ST STE 304
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2972
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Country | US
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Telephone | 219-980-2502
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Fax | 219-886-0245
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Provider Business Mailing Address
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Address Line | 6111 HARRISON ST STE 304
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2972
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Country | US
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Telephone | 219-980-2502
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Fax | 219-886-0245
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE E PRIMOS
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Credential | CMT
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Telephone | 219-980-2502
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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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