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General NPI Number Information
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NPI Number | 1932996188
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Entity Type | Organization
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Legal Business Name | CREATING SPACE MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 226 MAIN ST E STE B
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City | MENOMONIE
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State | WI
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Zip | 54751-2553
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Country | US
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Telephone | 715-308-9984
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Fax |
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Provider Business Mailing Address
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Address Line | 226 MAIN ST E STE B
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City | MENOMONIE
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State | WI
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Zip | 54751-2553
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Country | US
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Telephone | 715-308-9984
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLOE BECHER
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Credential | LMT, MMP
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Telephone | 715-308-9984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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