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General NPI Number Information
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NPI Number | 1427253657
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Entity Type | Organization
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Legal Business Name | INNERWAVES MASSAGE THERAPY
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2315 SOUTH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2970
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Country | US
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Telephone | 765-446-3883
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 SOUTH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2970
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Country | US
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Telephone | 765-446-3883
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Fax |
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Authorized Official
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Title or Position | OWNER, MASSAGE THERAPIST
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Name | MR. KIP TREECE
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Credential |
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Telephone | 765-446-3883
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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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