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General NPI Number Information
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NPI Number | 1760831705
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Entity Type | Organization
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Legal Business Name | NOSTALGIC PLIGHT LIVE LLC
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 144 E OLENTANGY ST
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City | POWELL
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State | OH
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Zip | 43065-9069
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Country | US
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Telephone | 614-547-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 144 E OLENTANGY ST
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City | POWELL
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State | OH
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Zip | 43065-9069
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Country | US
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Telephone | 614-547-9355
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Fax |
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Authorized Official
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Title or Position | OWNER/LMT
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Name | COURTNEY KRAUS
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Credential | LMT
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Telephone | 614-707-9887
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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 | 33.021127
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License Number State | OH
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