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General NPI Number Information
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NPI Number | 1912621996
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Entity Type | Organization
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Legal Business Name | NEA MASSAGE THERAPY, LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2909 KING ST STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5326
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Country | US
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Telephone | 870-219-9633
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 KING ST STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5326
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Country | US
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Telephone | 870-219-9633
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Fax |
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Authorized Official
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Title or Position | OWNER/INSTRUCTOR/THERAPIST
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Name | MRS. KRISTA MOORE
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Credential | MTI
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Telephone | 870-219-9633
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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 |
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License Number State |
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