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General NPI Number Information
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NPI Number | 1407107824
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Entity Type | Organization
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Legal Business Name | AARON'S ORTHOPEDIC MASSAGE, LLC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1021 RIVERBURCH PKWY
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City | DALTON
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State | GA
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Zip | 30721-8676
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Country | US
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Telephone | 706-508-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 RIVERBURCH PKWY
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City | DALTON
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State | GA
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Zip | 30721-8676
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Country | US
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Telephone | 706-508-3957
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH LILES
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Credential | LMT
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Telephone | 706-508-3957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MT005277
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License Number State | GA
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