MEDICARE: OASIS MOBILE MASSAGE & BODYWORK LLC

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	:	1750053971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS MOBILE MASSAGE & BODYWORK LLC

Provider Business Mailing Address
First Line	:	119 CLIFF WILLIAMS RD
Second Line	:
City	:	MAGEE
State	:	MS
Zip	:	39111-5026
Country	:	US
Telephone Number	:	769-226-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 EXECUTIVE PL STE 2C
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-4134
Country	:	US
Telephone Number	:	769-226-1925
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DARRELL DURELL WALKER JR.
Credential	:	LMT
Telephone Number	:	769-226-1925

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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