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General NPI Number Information
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NPI Number | 1962629089
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Entity Type | Organization
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Legal Business Name | MASSAGE FOR HEALTHY LIVING, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3949 EVANS AVE SUITE 109A
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City | FORT MYERS
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State | FL
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Zip | 33901-9335
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Country | US
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Telephone | 239-936-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7844
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City | FORT MYERS
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State | FL
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Zip | 33911-7844
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Country | US
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Telephone | 239-936-1111
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Fax | 239-936-1111
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIM VAN WINKLE
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Credential |
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Telephone | 239-936-1111
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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 | MM9897
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License Number State | FL
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