Provider Demographics
NPI:1154902872
Name:FLOURISH THERAPEUTIC MASSAGE
Entity type:Organization
Organization Name:FLOURISH THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:SIERRA
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-456-1501
Mailing Address - Street 1:222 S PETERS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5203
Mailing Address - Country:US
Mailing Address - Phone:865-456-1501
Mailing Address - Fax:
Practice Address - Street 1:222 S PETERS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5203
Practice Address - Country:US
Practice Address - Phone:865-456-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty