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General NPI Number Information
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NPI Number | 1952266819
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Entity Type | Organization
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Legal Business Name | KNEADED ESCAPE MASSAGE LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 3718 NE INDIAN RIVER DR UNIT A105
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4136
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Country | US
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Telephone | 772-530-1504
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 SE HAMDEN RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | NANCY SUE MORRISON
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Credential |
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Telephone | 772-530-1504
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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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