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General NPI Number Information
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NPI Number | 1902174469
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HEALING MASSAGE AND BODYWORK, LLC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 114 NE 14TH AVE
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City | OCALA
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State | FL
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Zip | 34470-6857
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Country | US
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Telephone | 352-232-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 20324 LAKE LINDSEY RD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-4403
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Country | US
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Telephone | 352-232-1795
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | REBECCA L RYAN
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Credential | LMT
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Telephone | 352-232-1795
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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 | MM27888
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License Number State | FL
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