Provider Demographics
NPI:1194911248
Name:ADVANCED MASSAGE THERAPY
Entity type:Organization
Organization Name:ADVANCED MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CLESSIE
Authorized Official - Last Name:JEAN-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-732-4719
Mailing Address - Street 1:2217 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3508
Mailing Address - Country:US
Mailing Address - Phone:954-767-0095
Mailing Address - Fax:
Practice Address - Street 1:2217 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3508
Practice Address - Country:US
Practice Address - Phone:954-767-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29366261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center