=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649566985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY TOUCH THERAPEUTIC MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2011
-----------------------------------------------------
Last Update Date | 06/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 THIMBLE SHOALS BLVD SUITE C
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-4547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-595-0029
-----------------------------------------------------
Fax | 757-595-8911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 THIMBLE SHOALS BLVD SUITE C
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-4547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-595-0029
-----------------------------------------------------
Fax | 757-595-8911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JENNIFER WHEATLEY
-----------------------------------------------------
Credential | NCMT
-----------------------------------------------------
Telephone | 757-595-0029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 19003874
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------