Provider Demographics
NPI:1063750552
Name:FASSAGE EXCELLENCE IN SKIN CARE, MAKEUP & MASSAGE, LLC
Entity type:Organization
Organization Name:FASSAGE EXCELLENCE IN SKIN CARE, MAKEUP & MASSAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TORHILD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-575-2855
Mailing Address - Street 1:725 N A1A
Mailing Address - Street 2:C-114
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4571
Mailing Address - Country:US
Mailing Address - Phone:561-575-2855
Mailing Address - Fax:561-575-4600
Practice Address - Street 1:725 N A1A
Practice Address - Street 2:C-114
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4571
Practice Address - Country:US
Practice Address - Phone:561-575-2855
Practice Address - Fax:561-575-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty