Provider Demographics
NPI:1386464014
Name:THAT ZEN LADY LLC
Entity type:Organization
Organization Name:THAT ZEN LADY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:336-378-5084
Mailing Address - Street 1:161 HWY 42
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203
Mailing Address - Country:US
Mailing Address - Phone:336-378-5084
Mailing Address - Fax:
Practice Address - Street 1:161 HWY 42
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-378-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty