Provider Demographics
NPI:1932334679
Name:FULL THROTTLE MASSAGE, INC.
Entity type:Organization
Organization Name:FULL THROTTLE MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:423-870-8611
Mailing Address - Street 1:4121 HIXSON PIKE
Mailing Address - Street 2:SUITE A7
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3125
Mailing Address - Country:US
Mailing Address - Phone:423-870-8611
Mailing Address - Fax:
Practice Address - Street 1:4121 HIXSON PIKE
Practice Address - Street 2:SUITE A7
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3125
Practice Address - Country:US
Practice Address - Phone:423-870-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNME2704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty