Provider Demographics
NPI:1427557370
Name:WELL KNEADED MASSAGE, INC
Entity type:Organization
Organization Name:WELL KNEADED MASSAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSOP
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BCTMB
Authorized Official - Phone:406-360-7491
Mailing Address - Street 1:12832 AGATE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9584
Mailing Address - Country:US
Mailing Address - Phone:406-360-7491
Mailing Address - Fax:
Practice Address - Street 1:3946 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6425
Practice Address - Country:US
Practice Address - Phone:406-360-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty