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General NPI Number Information
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NPI Number | 1376153866
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Entity Type | Organization
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Legal Business Name | ENCOURAGING BALANCE MASSAGE THERAPY, LLC
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Dates
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Enumeration Date | 08/09/2020
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Last Update Date | 08/09/2020
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Provider Practice Location Address
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Address Line | 145 CHURCH ST NE STE 103
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City | MARIETTA
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State | GA
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Zip | 30060-1691
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Country | US
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Telephone | 404-987-0624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 256
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City | MARIETTA
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State | GA
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Zip | 30061-0256
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Country | US
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Telephone | 404-987-0624
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST / OWNER
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Name | LINDA NORDAHL
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Credential | LMT
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Telephone | 404-987-0624
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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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