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General NPI Number Information
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NPI Number | 1386464014
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Entity Type | Organization
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Legal Business Name | THAT ZEN LADY LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 161 HWY 42 SUITE C
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City | ASHEBORO
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State | NC
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Zip | 27203
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Country | US
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Telephone | 336-378-5084
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Fax |
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Provider Business Mailing Address
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Address Line | 161 HWY 42 SUITE C
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City | ASHEBORO
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State | NC
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Zip | 27203
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Country | US
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Telephone | 336-378-5084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS MARY BETH KILMORE
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Credential | LMT
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Telephone | 336-378-5084
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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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