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General NPI Number Information
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NPI Number | 1861710444
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Entity Type | Organization
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Legal Business Name | 4 KEYS WELLNESS INC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 2134 NICHOLASVILLE RD SUITE 5
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City | LEXINGTON
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State | KY
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Zip | 40503-2521
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Country | US
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Telephone | 859-368-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 2134 NICHOLASVILLE RD SUITE 5
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City | LEXINGTON
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State | KY
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Zip | 40503-2521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH CINQUINA
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Credential | LMT, NCBTMB
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Telephone | 859-368-9355
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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 | 2175
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License Number State | KY
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