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General NPI Number Information
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NPI Number | 1568185668
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Entity Type | Organization
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Legal Business Name | WILLOW TREE MASSAGE
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1548 S US HIGHWAY 231 STE E1
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City | OZARK
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State | AL
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Zip | 36360-4516
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Country | US
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Telephone | 334-443-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 1548 S US HIGHWAY 231 STE E1
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City | OZARK
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State | AL
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Zip | 36360-4516
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Country | US
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Telephone | 334-443-0460
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Fax |
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Authorized Official
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Title or Position | CO-OWNER & MASSAGE THERAPIST
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Name | ANNA M DEAL
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Credential | LMT
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Telephone | 334-443-0460
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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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