=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285121301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ABOUT MASSAGE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2018
-----------------------------------------------------
Last Update Date | 04/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74125 HIGHWAY 111
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-346-7949
-----------------------------------------------------
Fax | 760-346-7949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74125 HIGHWAY 111
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-346-7949
-----------------------------------------------------
Fax | 760-346-7949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, OWNER
-----------------------------------------------------
Name | KELLY ANN YAMADA
-----------------------------------------------------
Credential | CMT
-----------------------------------------------------
Telephone | 760-346-7949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 11332
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------