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General NPI Number Information
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NPI Number | 1619280724
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Entity Type | Organization
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Legal Business Name | ATLANTIS THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 07/17/2010
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Last Update Date | 07/17/2010
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Provider Practice Location Address
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Address Line | 46 KING HILL RD
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-1759
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Country | US
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Telephone | 860-429-8106
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 694
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-0694
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Country | US
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Telephone | 860-429-8106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA ANDERSON
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Credential | LMT
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Telephone | 860-429-8106
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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 | 002104
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License Number State | CT
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