MEDICARE: KNEADED MOMENTS 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	172M00000X	Mechanotherapist	33017699	OH
2	172M00000X	Mechanotherapist	33010862	OH
3	172M00000X	Mechanotherapist	33019158	OH

General Provider Information

NPI Number	:	1720436090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNEADED MOMENTS MASSAGE

Provider Business Mailing Address
First Line	:	5650 W CENTRAL AVE
Second Line	:	SUITE C2
City	:	TOLEDO
State	:	OH
Zip	:	43615-1519
Country	:	US
Telephone Number	:	419-315-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 W CENTRAL AVE
Second Line	:	SUITE C2
City	:	TOLEDO
State	:	OH
Zip	:	43615-1519
Country	:	US
Telephone Number	:	419-315-5010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER M HERTZFELD
Credential	:
Telephone Number	:	419-315-5010

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/27/2016

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Directions to “KNEADED MOMENTS MASSAGE ” Practice Location

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