Provider Demographics
NPI:1124316591
Name:CLASSIC TOUCH MASSAGE, INC.
Entity type:Organization
Organization Name:CLASSIC TOUCH MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-687-7607
Mailing Address - Street 1:3821 WOODFIELD CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2238
Mailing Address - Country:US
Mailing Address - Phone:954-579-5599
Mailing Address - Fax:
Practice Address - Street 1:8177 GLADES RD
Practice Address - Street 2:SUITE 221
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4071
Practice Address - Country:US
Practice Address - Phone:954-579-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C2498OtherBCBS