Provider Demographics
NPI:1902174469
Name:ESSENTIAL HEALING MASSAGE AND BODYWORK, LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALING MASSAGE AND BODYWORK, LLC
Other - Org Name:ESSENTIAL HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-232-1795
Mailing Address - Street 1:20324 LAKE LINDSEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-4403
Mailing Address - Country:US
Mailing Address - Phone:352-232-1795
Mailing Address - Fax:
Practice Address - Street 1:114 NE 14TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6857
Practice Address - Country:US
Practice Address - Phone:352-232-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM27888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM27888OtherMASSAGE ESTABLISHMENT NUMBER