Provider Demographics
NPI:1003210998
Name:MITCHELL MASSAGE WORKZ LLC
Entity Type:Organization
Organization Name:MITCHELL MASSAGE WORKZ LLC
Other - Org Name:MASSAGE WORKZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:HOMMEMA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-682-5671
Mailing Address - Street 1:4001 W NEWBERRY RD
Mailing Address - Street 2:C3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2392
Mailing Address - Country:US
Mailing Address - Phone:352-450-4037
Mailing Address - Fax:
Practice Address - Street 1:4001 W NEWBERRY RD
Practice Address - Street 2:C3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2392
Practice Address - Country:US
Practice Address - Phone:352-450-4037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM32943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty