Provider Demographics
NPI:1194342931
Name:FULL CIRCLE MASSAGE THERAPY LLC
Entity type:Organization
Organization Name:FULL CIRCLE MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:PENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT, BCTMB
Authorized Official - Phone:828-606-0258
Mailing Address - Street 1:3754 BREVARD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-8809
Mailing Address - Country:US
Mailing Address - Phone:828-606-0258
Mailing Address - Fax:
Practice Address - Street 1:3754 BREVARD RD STE 105
Practice Address - Street 2:
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-8809
Practice Address - Country:US
Practice Address - Phone:828-606-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty