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General NPI Number Information
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NPI Number | 1740616374
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Entity Type | Organization
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Legal Business Name | LOW COUNTRY MASSAGE & WELLNESS, LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 829 FRONT ST SUITE H
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City | GEORGETOWN
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State | SC
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Zip | 29440-3563
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Country | US
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Telephone | 901-896-6024
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Fax |
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Provider Business Mailing Address
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Address Line | 913 LAKESIDE DR
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City | GEORGETOWN
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State | SC
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Zip | 29440-4325
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Country | US
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Telephone | 901-896-6024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BLAKELY RENEE ALTMAN
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Credential | LMT
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Telephone | 901-896-6024
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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 | 6530
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License Number State | SC
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