Provider Demographics
NPI:1760229066
Name:KEEP YOUNG MASSAGE LLC
Entity type:Organization
Organization Name:KEEP YOUNG MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PRAC MA85566
Authorized Official - Phone:352-561-2991
Mailing Address - Street 1:510 CO. ROAD 466
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-561-2991
Mailing Address - Fax:
Practice Address - Street 1:510 CO. ROAD 466
Practice Address - Street 2:SUITE 207
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-561-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty