Provider Demographics
NPI:1699947093
Name:LIVING WELL MASSAGE, INC.
Entity type:Organization
Organization Name:LIVING WELL MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAGEFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-917-7575
Mailing Address - Street 1:3301 S PALM AIRE DR
Mailing Address - Street 2:#208
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4280
Mailing Address - Country:US
Mailing Address - Phone:954-917-7575
Mailing Address - Fax:954-917-7576
Practice Address - Street 1:3301 S PALM AIRE DR
Practice Address - Street 2:#208
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4280
Practice Address - Country:US
Practice Address - Phone:954-917-7575
Practice Address - Fax:954-917-7576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING WELL MASSAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 24120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty