=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992988554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUSCLE THERAPIES USA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 12/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 E FORT KING ST SUITE B2
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-369-4357
-----------------------------------------------------
Fax | 352-402-0276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 E FORT KING ST SUITE B2
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-369-4357
-----------------------------------------------------
Fax | 352-402-0276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | MS. ROBYN TALIA KILEY
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 352-369-4357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | #MM20676
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------