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General NPI Number Information
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NPI Number | 1437549524
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Entity Type | Organization
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Legal Business Name | MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 500 NE SPANISH RIVER BLVD STE 35
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City | BOCA RATON
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State | FL
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Zip | 33431-4517
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Country | US
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Telephone | 561-789-8953
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Fax |
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Provider Business Mailing Address
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Address Line | 2621 CRABAPPLE CIR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-6640
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Country | US
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Telephone | 561-789-8953
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEITH G GARVIN
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Credential | LMT
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Telephone | 561-789-8953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA53020
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License Number State | FL
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