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General NPI Number Information
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NPI Number | 1831291475
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Entity Type | Individual
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Provider Name | MISTY MURRAY LMT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 10071 BROAD RIVER RD STE B
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City | IRMO
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State | SC
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Zip | 29063-2381
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Country | US
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Telephone | 803-445-1069
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Fax |
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Provider Business Mailing Address
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Address Line | 120 THAMES VALLEY CT
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City | IRMO
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State | SC
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Zip | 29063-2407
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Country | US
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Telephone | 803-269-6622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2005-1799
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3637
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License Number State | SC
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