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General NPI Number Information
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NPI Number | 1548773914
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INDULGENCE
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 903 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46617-3103
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Country | US
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Telephone | 574-520-1664
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Fax |
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Provider Business Mailing Address
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Address Line | 903 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46617-3103
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Country | US
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Telephone | 574-520-1664
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARA ROS FRAZIER
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Credential | LMT, CLDT
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Telephone | 574-520-1664
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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 | 17-00007650
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License Number State | IN
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