Provider Demographics
NPI:1962554923
Name:THERA-SSAGE
Entity type:Organization
Organization Name:THERA-SSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB, LMBT
Authorized Official - Phone:828-288-3727
Mailing Address - Street 1:431 S MAIN ST
Mailing Address - Street 2:STE.2
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2946
Mailing Address - Country:US
Mailing Address - Phone:828-288-3727
Mailing Address - Fax:828-288-6205
Practice Address - Street 1:431 S MAIN ST
Practice Address - Street 2:STE.2
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2946
Practice Address - Country:US
Practice Address - Phone:828-288-3727
Practice Address - Fax:828-288-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310171100000X
NC1042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty