=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982984654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RELAXATION POINT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2011
-----------------------------------------------------
Last Update Date | 08/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 W BUFFALO ST
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-4114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-379-1639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 36
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14882-0036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-379-1639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSEPH HOLMGREN
-----------------------------------------------------
Credential | L.M.T.
-----------------------------------------------------
Telephone | 607-379-1639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------