MEDICARE: MOBILE MASSAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1629796008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MASSAGE

Provider Business Mailing Address
First Line	:	3336 N 32ND ST STE 114
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6241
Country	:	US
Telephone Number	:	623-322-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 N 32ND ST STE 114
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6241
Country	:	US
Telephone Number	:	623-322-0730
Fax Number	:	623-374-4592

Authorized Official
Title or Position	:	PROVIDER
Name	:	JENNA HALL
Credential	:
Telephone Number	:	480-233-5494

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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Directions to “MOBILE MASSAGE ” Practice Location

Language	Start Address	Practice Location

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