=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861996969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAILORED TOUCH MASSAGE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2018
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22267 SUMMIT VUE LN
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-7248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-297-6268
-----------------------------------------------------
Fax | 747-226-1444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22267 SUMMIT VUE LN
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-7248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-297-6268
-----------------------------------------------------
Fax | 747-226-1444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TONYA BLADES-BARRETT
-----------------------------------------------------
Credential | LMT MMP
-----------------------------------------------------
Telephone | 818-297-6268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 3008
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------