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General NPI Number Information
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NPI Number | 1902221385
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC & PAIN MANAGEMENT MASSAGE THERAPY
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 105 ROBINS WAY SUITE 204
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1129
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Country | US
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Telephone | 270-893-8706
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Fax | 888-704-8506
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Provider Business Mailing Address
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Address Line | 105 ROBINS WAY SUITE 204
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1129
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Country | US
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Telephone | 270-893-8706
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Fax | 888-704-8506
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Authorized Official
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Title or Position | MASSAGE THERAPIST/OWNER
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Name | MRS. REBECCA E. HANKINS
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Credential | LMT, MMP
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Telephone | 270-893-8706
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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 | KY-3935
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License Number State | KY
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