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General NPI Number Information
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NPI Number | 1568707313
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Entity Type | Organization
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Legal Business Name | KNOW KNOTS MASSAGE
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 8052 LIMONITE AVE STE 104
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City | RIVERSIDE
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State | CA
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Zip | 92509-6124
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Country | US
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Telephone | 951-581-3242
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Fax | 951-213-6761
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Provider Business Mailing Address
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Address Line | 52 ROUND TABLE DR
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City | RIVERSIDE
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State | CA
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Zip | 92507-6998
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Country | US
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Telephone | 951-581-3242
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Fax | 951-213-6761
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Authorized Official
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Title or Position | OWNER
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Name | MR. RANDALL JEAGER WORTHINGTON III
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Credential | C.M.T
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Telephone | 951-581-3242
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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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