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General NPI Number Information
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NPI Number | 1982011656
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Entity Type | Organization
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Legal Business Name | KNEADED ENERGY, INC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 321 W WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-8401
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Country | US
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Telephone | 336-273-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 321 W WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-8401
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Country | US
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Telephone | 336-273-1260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM NORMAN
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Credential | LMBT
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Telephone | 336-273-1260
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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 | 1601
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License Number State | NC
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