Provider Demographics
NPI:1356624704
Name:LIFESTYLES MASSAGE INC
Entity type:Organization
Organization Name:LIFESTYLES MASSAGE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:207-376-3233
Mailing Address - Street 1:600 TURNER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5299
Mailing Address - Country:US
Mailing Address - Phone:207-376-3233
Mailing Address - Fax:207-376-3236
Practice Address - Street 1:600 TURNER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5299
Practice Address - Country:US
Practice Address - Phone:207-376-3233
Practice Address - Fax:207-376-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty