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General NPI Number Information
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NPI Number | 1770969032
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Entity Type | Organization
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Legal Business Name | SIMPLE MASSAAGE, LLC
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Dates
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Enumeration Date | 08/09/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 3709 N 9TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-5015
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Country | US
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Telephone | 480-525-7322
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 N 9TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-5015
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Country | US
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Telephone | 480-525-7322
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MR. JOSHUA SCOFIELD
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Credential | LMT
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Telephone | 480-525-7322
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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 | MT08021
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License Number State | AZ
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