| Organization Name: | BLUEGRASS MASSAGE THERAPUTICS |
| NPI Number: | 1427240704 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE LEIGH POFF (MASSAGE THERAPIST) |
| Mailing Address: | 365 East Broadway Suite 2 Brandenburg |
| State: | KY US |
| Postal Code: | 40108 |
| Phone Number: | 2704223694 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2007 |
| NPI Last Update Date: | 08/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | KY2052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |