Provider Demographics
NPI:1215459250
Name:CAROLINA MASSAGE THERAPY
Entity type:Organization
Organization Name:CAROLINA MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-570-6556
Mailing Address - Street 1:2006 S MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9391
Mailing Address - Country:US
Mailing Address - Phone:919-570-6556
Mailing Address - Fax:919-882-1141
Practice Address - Street 1:2006 S MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9391
Practice Address - Country:US
Practice Address - Phone:919-570-6556
Practice Address - Fax:919-882-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty