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General NPI Number Information
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NPI Number | 1740518513
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Entity Type | Organization
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Legal Business Name | TUCSON MYOFASCIAL RELEASE & MASSAGE LLC
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Dates
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Enumeration Date | 12/06/2009
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Last Update Date | 12/06/2009
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Provider Practice Location Address
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Address Line | 850 N KOLB RD
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City | TUCSON
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State | AZ
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Zip | 85710-1333
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Country | US
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Telephone | 520-971-4866
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Fax | 520-733-0406
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Provider Business Mailing Address
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Address Line | 7739 E BROADWAY BLVD 83
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City | TUCSON
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State | AZ
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Zip | 85710-3941
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Country | US
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Telephone | 520-971-4866
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Fax | 520-733-0406
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Authorized Official
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Title or Position | OWNER
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Name | KATHY D JOHNSON
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Credential | LMT
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Telephone | 520-971-4866
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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 | MT-12870
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License Number State | AZ
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