=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497237606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUCH OF LIFE MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2018
-----------------------------------------------------
Last Update Date | 09/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 E UNIVERSITY DR STE 102
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85203-8235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-256-9359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 E UNIVERSITY DR STE 102
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85203-8235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-256-9359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES ALFORD ALFORD II
-----------------------------------------------------
Credential | MT
-----------------------------------------------------
Telephone | 480-256-9359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT-07466
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------