=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487450771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANI: A CLEANSING PLACE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 S MAIN ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38103-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-621-6712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 TANGLEWOOD ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38114-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-621-6712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, LICENSED MASSAGE THERAPIST
-----------------------------------------------------
Name | EMMA CRYSTAL
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 901-240-8867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------