Provider Demographics
NPI:1427744507
Name:MASSAGE INK, LLC
Entity type:Organization
Organization Name:MASSAGE INK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-204-0320
Mailing Address - Street 1:PO BOX 3753
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-3753
Mailing Address - Country:US
Mailing Address - Phone:949-204-0320
Mailing Address - Fax:
Practice Address - Street 1:128 AVENIDA SAN DIMAS APT C
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-1417
Practice Address - Country:US
Practice Address - Phone:949-204-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty