Provider Demographics
NPI:1063707222
Name:SAN ANTONIO MASSAGE & SPA
Entity type:Organization
Organization Name:SAN ANTONIO MASSAGE & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-349-0550
Mailing Address - Street 1:7330 SAN PEDRO AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6235
Mailing Address - Country:US
Mailing Address - Phone:210-349-0550
Mailing Address - Fax:210-340-6557
Practice Address - Street 1:7330 SAN PEDRO AVE
Practice Address - Street 2:STE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-349-0550
Practice Address - Fax:210-340-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT016889172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty