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General NPI Number Information
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NPI Number | 1871733147
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Entity Type | Organization
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Legal Business Name | ESSENTIAL ESCAPES
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 6043 NW 167TH STREET SUITE A17
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City | MIAMI
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State | FL
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Zip | 33015-4341
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Country | US
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Telephone | 305-770-2221
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Fax | 303-459-7915
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Provider Business Mailing Address
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Address Line | 6043 NW 167TH STREET SUITE A17
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City | MIAMI
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State | FL
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Zip | 33015-4341
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Country | US
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Telephone | 305-770-2221
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Fax | 303-459-7915
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Authorized Official
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Title or Position | PRES
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Name | MR. DOUGLAS THOMPSON
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Credential |
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Telephone | 305-770-2221
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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 | MM21879
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License Number State | FL
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