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General NPI Number Information
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NPI Number | 1780281097
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Entity Type | Organization
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Legal Business Name | LIVING HEALTHY MASSAGE INC.
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 6749 NW 62ND PL
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City | OCALA
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State | FL
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Zip | 34482-8443
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Country | US
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Telephone | 352-817-8823
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Fax |
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Provider Business Mailing Address
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Address Line | 6749 NW 62ND PL
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City | OCALA
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State | FL
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Zip | 34482-8443
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Country | US
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Telephone | 352-817-8823
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. DERRICK A HENDERSON
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Credential | MA65820
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Telephone | 352-817-8823
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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 |
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License Number State |
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