Provider Demographics
NPI:1033314554
Name:HEALING TABLES LTD CO
Entity Type:Organization
Organization Name:HEALING TABLES LTD CO
Other - Org Name:HEALING THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER.THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:859-431-5777
Mailing Address - Street 1:405 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1011
Mailing Address - Country:US
Mailing Address - Phone:859-781-2328
Mailing Address - Fax:
Practice Address - Street 1:405 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073
Practice Address - Country:US
Practice Address - Phone:859-781-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0420527171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty