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General NPI Number Information
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NPI Number | 1376013813
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Entity Type | Organization
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Legal Business Name | QUALITY THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 423 TAZOR ST NW
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City | ATLANTA
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State | GA
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Zip | 30314-2718
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Country | US
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Telephone | 678-612-1051
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 115294
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City | ATLANTA
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State | GA
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Zip | 30310
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Country | US
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Telephone | 678-612-1051
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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 | MS. STACY GLINTON
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Credential | LMT
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Telephone | 678-612-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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