=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861701658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASSAGE ANGLES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2010
-----------------------------------------------------
Last Update Date | 09/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 S FEDERAL HWY
-----------------------------------------------------
City | DANIA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-834-3251
-----------------------------------------------------
Fax | 954-456-3733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 S FEDERAL HWY
-----------------------------------------------------
City | DANIA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-834-3251
-----------------------------------------------------
Fax | 954-456-3733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | MELODIE ROSE TORRES-COLE
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 954-834-3251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA34917
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------