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General NPI Number Information
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NPI Number | 1437494069
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Entity Type | Organization
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Legal Business Name | FIVE BALANCED ELEMENTS
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Dates
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Enumeration Date | 12/08/2012
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Last Update Date | 12/08/2012
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Provider Practice Location Address
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Address Line | 1515 S VIRGINIA ST
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City | RENO
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State | NV
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Zip | 89502-2807
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Country | US
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Telephone | 775-762-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 S VIRGINIA ST
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City | RENO
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State | NV
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Zip | 89502-2807
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Country | US
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Telephone | 775-762-3393
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | REBECCA IJEKAH
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Credential | LMT
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Telephone | 775-762-3393
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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 | 5399
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License Number State | NV
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