=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922988641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUSCLE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5840 LAKESHORE DR APT 327
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-6468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-601-9154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3389 SHERIDAN ST UNIT 282
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-601-9154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SIVANNE GUENOUN
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 347-601-9154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------