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General NPI Number Information
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NPI Number | 1760956437
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Entity Type | Organization
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Legal Business Name | HANDS OF LIFE LLC
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 425 E CROSSVILLE RD STE E-111
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City | ROSWELL
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State | GA
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Zip | 30075-5817
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Country | US
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Telephone | 770-740-2609
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Fax |
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Provider Business Mailing Address
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Address Line | 425 E CROSSVILLE RD STE E-111
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City | ROSWELL
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State | GA
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Zip | 30075-5817
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Country | US
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Telephone | 770-740-2609
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | AYESHA NESBETH-AGUILA
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Credential | LMT, CCP
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Telephone | 770-740-2609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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