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General NPI Number Information
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NPI Number | 1568115673
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Entity Type | Organization
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Legal Business Name | GREAT MASSAGE AND FACIAL SPA
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 100 PAVILION WAY
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4559
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Country | US
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Telephone | 910-315-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PAVILION WAY STE E
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4560
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Country | US
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Telephone | 910-315-0402
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LILLIAN IMOSE OBAZEE
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Credential | LPN
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Telephone | 470-643-1175
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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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