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General NPI Number Information
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NPI Number | 1669503199
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Entity Type | Organization
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Legal Business Name | ALBANY THERAPEUTIC MASSAGE CLINIC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1534 DAWSON RD
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City | ALBANY
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State | GA
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Zip | 31707
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Country | US
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Telephone | 229-435-9008
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Fax | 229-435-9080
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Provider Business Mailing Address
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Address Line | 1534 DAWSON RD
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City | ALBANY
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State | GA
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Zip | 31707
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Country | US
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Telephone | 229-435-9008
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Fax | 229-435-9080
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Authorized Official
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Title or Position | PRES
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Name | MS. VIVIAN L DAVIS
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Credential | MASSAGE THERAPIST
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Telephone | 229-435-9008
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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 | MA10936
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT000009
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License Number State | GA
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