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General NPI Number Information
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NPI Number | 1457106890
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Entity Type | Organization
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Legal Business Name | MINERAL AREA MASSAGE LLC
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 301 N WASHINGTON ST STE 6
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City | FARMINGTON
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State | MO
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Zip | 63640-1750
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Country | US
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Telephone | 573-430-9963
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 STATE HIGHWAY 32
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City | PARK HILLS
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State | MO
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Zip | 63601-8207
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Country | US
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Telephone | 573-430-9963
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | RAYMOND MICHAEL CAMDEN
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Credential | LMT
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Telephone | 573-430-9963
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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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