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General NPI Number Information
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NPI Number | 1447446745
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MASSAGE, INC.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 413 CALIFORNIA AVE
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City | STUART
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State | FL
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Zip | 34994-2917
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Country | US
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Telephone | 772-288-3095
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Fax |
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Provider Business Mailing Address
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Address Line | 413 CALIFORNIA AVE
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City | STUART
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State | FL
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Zip | 34994-2917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MICHELLE L MCCRAIN
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Credential | LMT
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Telephone | 772-288-3095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA0004514
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License Number State | FL
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