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General NPI Number Information
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NPI Number | 1972925337
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Entity Type | Organization
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Legal Business Name | RESTORE & RENEW MEDICAL MASSAGE
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 318 W. WASHINGTON ST. SUITE B
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City | LEWISBURG
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State | WV
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Zip | 24901-1316
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Country | US
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Telephone | 304-647-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 318 W. WASHINGTON ST. SUITE B
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City | LEWISBURG
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State | WV
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Zip | 24901-1316
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Country | US
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Telephone | 304-647-3233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE C EWING
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Credential | LMT, PTA
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Telephone | 304-647-3233
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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 | 2001-1648
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License Number State | WV
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