Provider Demographics
NPI:1215605464
Name:KRAKEN MASSAGE AND BODY LLC
Entity type:Organization
Organization Name:KRAKEN MASSAGE AND BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/LMT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:KIYOKI
Authorized Official - Last Name:RYKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CCT
Authorized Official - Phone:512-447-4640
Mailing Address - Street 1:3624 ROSALINA LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD STE 26
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3991
Practice Address - Country:US
Practice Address - Phone:512-774-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy