Organization Name: | EDEN MASSAGE & SPA, INC |
NPI Number: | 1194982140 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GRACE OKON PAUL (OWNER/PRESIDENT) |
Mailing Address: | 2655 E Oakland Park Blvd Suite #2 Fort Lauderdale |
State: | FL US |
Postal Code: | 333061608 |
Phone Number: | 9545649536 |
Fax Number: | 9545652910 |
NPI Enumeration Date: | 05/19/2008 |
NPI Last Update Date: | 05/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | LIC #19555 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |