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General NPI Number Information
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NPI Number | 1306644307
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Entity Type | Organization
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Legal Business Name | EBB AND FLOW MASSAGE THERAPY, LLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 14 MONCKTON BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-4710
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Country | US
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Telephone | 803-820-9811
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Fax |
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Provider Business Mailing Address
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Address Line | 186 FOX MEADOW LN
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City | HOPKINS
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State | SC
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Zip | 29061-9530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | EBONEE HICKS
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Credential | LMT
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Telephone | 839-849-4785
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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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