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General NPI Number Information
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NPI Number | 1902025711
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC BODYWORK & MASSAGE, INC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 E 7TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3032
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Country | US
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Telephone | 850-747-1277
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Fax | 850-784-4441
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Provider Business Mailing Address
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Address Line | 303 E 7TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3032
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Country | US
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Telephone | 850-747-1277
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Fax | 850-784-4441
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARY ELIZABETH FUSILIER
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Credential | L.M.T.
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Telephone | 850-747-1277
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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 | MA 41685
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License Number State | FL
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