Provider Demographics
NPI:1750955381
Name:MASSAGE FOR ATHLETES, INC.
Entity type:Organization
Organization Name:MASSAGE FOR ATHLETES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-541-6258
Mailing Address - Street 1:418 AVIATION BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1074
Mailing Address - Country:US
Mailing Address - Phone:707-541-6258
Mailing Address - Fax:707-284-0122
Practice Address - Street 1:418 AVIATION BLVD STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1074
Practice Address - Country:US
Practice Address - Phone:707-541-6258
Practice Address - Fax:707-284-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain