=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780185124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUANTUM HEALING THERAPIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2018
-----------------------------------------------------
Last Update Date | 02/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 570 N STATE ST STE 210
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-7135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-429-1231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8520 OLENCREST DR
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-8870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-429-1231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANINE MANSELL
-----------------------------------------------------
Credential | L.AC, L.M.T
-----------------------------------------------------
Telephone | 516-429-1231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 33.021310
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 65.000321
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------