Provider Demographics
NPI:1154172369
Name:REJUVENATION MASSAGE THERAPY LLC
Entity type:Organization
Organization Name:REJUVENATION MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-855-1560
Mailing Address - Street 1:370 CARAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2837
Mailing Address - Country:US
Mailing Address - Phone:406-855-1560
Mailing Address - Fax:
Practice Address - Street 1:2822 3RD AVE N STE 204
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1934
Practice Address - Country:US
Practice Address - Phone:406-855-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty