=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427202019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUSCULUM THERAPEUTIC MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2008
-----------------------------------------------------
Last Update Date | 11/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3540 COLUMBIA PKWY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45226-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-505-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3540 COLUMBIA PKWY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45226-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-505-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. WILLIAM ROBERT HULSIZER
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 513-505-3541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 33017166
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------