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General NPI Number Information
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NPI Number | 1699947093
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Entity Type | Organization
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Legal Business Name | LIVING WELL MASSAGE, INC.
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 3301 S PALM AIRE DR #208
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4280
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Country | US
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Telephone | 954-917-7575
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Fax | 954-917-7576
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Provider Business Mailing Address
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Address Line | 3301 S PALM AIRE DR #208
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4280
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Country | US
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Telephone | 954-917-7575
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Fax | 954-917-7576
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA J KAGEFF
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Credential | LMT
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Telephone | 954-917-7575
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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 | MA 24120
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License Number State | FL
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