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General NPI Number Information
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NPI Number | 1821767153
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Entity Type | Organization
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Legal Business Name | MASSAGE BY MICAH LLC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 913 GULF BREEZE PKWY STE 36
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City | GULF BREEZE
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State | FL
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Zip | 32561-4729
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Country | US
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Telephone | 850-449-5631
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Fax |
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Provider Business Mailing Address
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Address Line | 5909 ROBLE LOMA DR
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City | PENSACOLA
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State | FL
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Zip | 32526-2250
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Country | US
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Telephone | 850-449-5631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICAH BALDWIN
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Credential |
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Telephone | 850-449-5631
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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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