Provider Demographics
NPI:1033472162
Name:EXPRESS YOURSELF CT, LLC
Entity Type:Organization
Organization Name:EXPRESS YOURSELF CT, LLC
Other - Org Name:THE BACK RUB MASSAGE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:203-660-8016
Mailing Address - Street 1:82 BURNSIDE AVE
Mailing Address - Street 2:REAR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3413
Mailing Address - Country:US
Mailing Address - Phone:203-660-8016
Mailing Address - Fax:860-578-9007
Practice Address - Street 1:82 BURNSIDE AVE
Practice Address - Street 2:REAR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3413
Practice Address - Country:US
Practice Address - Phone:203-660-8016
Practice Address - Fax:860-578-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006229251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management