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General NPI Number Information
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NPI Number | 1821585175
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Entity Type | Organization
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Legal Business Name | KNEEDED BALANCE AND TRANQUILITY
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Dates
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Enumeration Date | 04/21/2018
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Last Update Date | 04/21/2018
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Provider Practice Location Address
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Address Line | 3708 S. LAFOUNTAIN ST
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City | KOKOMO
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State | IN
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Zip | 46902
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Country | US
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Telephone | 765-865-7683
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Fax |
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Provider Business Mailing Address
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Address Line | 3708 S. LAFOUNTAIN ST
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City | KOKOMO
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State | IN
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Zip | 46902
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Country | US
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Telephone | 765-865-7683
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JULIA ANN SAULMON
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Credential | CMMP, CMT, RN
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Telephone | 765-865-7683
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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 | MT21605888
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License Number State | IN
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