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General NPI Number Information
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NPI Number | 1336021286
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Entity Type | Organization
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Legal Business Name | EDEN STATE, LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 80 S MAIN ST
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City | LOBELVILLE
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State | TN
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Zip | 37097-3276
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Country | US
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Telephone | 615-475-8293
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Fax |
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Provider Business Mailing Address
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Address Line | 32 DUNCAN CIR
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City | LOBELVILLE
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State | TN
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Zip | 37097-3428
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Country | US
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Telephone | 615-720-8029
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Fax |
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | KYLE PERRY
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Credential | LMT #12802
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Telephone | 615-720-8029
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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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