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General NPI Number Information
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NPI Number | 1558661678
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Entity Type | Organization
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Legal Business Name | ACUITY THERAPEUTIC MASSAGE & BODYWORK
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 820 E PARK AVE BLDG A SUITE 200
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2610
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Country | US
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Telephone | 850-570-0673
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Fax | 850-222-9355
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Provider Business Mailing Address
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Address Line | 820 E PARK AVE BLDG A
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2610
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Country | US
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Telephone | 850-570-0673
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Fax | 850-222-9355
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Authorized Official
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Title or Position | OWNER/LMT
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Name | MS. ALEXI JESSLYN NICHOLS
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Credential | LMT, NCBTMB
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Telephone | 850-570-0673
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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 | MA57166
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MM25008
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License Number State | FL
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