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General NPI Number Information
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NPI Number | 1619177326
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Entity Type | Organization
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Legal Business Name | A TOUCH OF HEAVEN MASSAGE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 620 E MAIN ST
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City | LAKE BUTLER
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State | FL
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Zip | 32054-1331
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Country | US
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Telephone | 386-496-1347
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Fax | 386-496-1247
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Provider Business Mailing Address
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Address Line | 620 E MAIN ST
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City | LAKE BUTLER
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State | FL
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Zip | 32054-1331
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Country | US
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Telephone | 386-496-1347
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Fax | 386-496-1247
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CATHERINE DENISE WILLIAMS
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Credential | LMT
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Telephone | 386-496-1347
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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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