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General NPI Number Information
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NPI Number | 1831955731
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Entity Type | Organization
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Legal Business Name | UNIVERS MEDICAL MASSAGE
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 110 CROSS PARK DR
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City | PEARL
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State | MS
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Zip | 39208-9016
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Country | US
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Telephone | 601-506-5784
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Fax | 601-397-6732
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Provider Business Mailing Address
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Address Line | 110 CROSS PARK DR STE A
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City | PEARL
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State | MS
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Zip | 39208-9016
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Country | US
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Telephone | 601-506-5784
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONIKA V WILSON
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Credential |
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Telephone | 601-506-5784
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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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