Provider Demographics
NPI:1033527692
Name:THERAPEUTIC CONNECTION MASSAGE & WELLNESS SPA
Entity Type:Organization
Organization Name:THERAPEUTIC CONNECTION MASSAGE & WELLNESS SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:I
Authorized Official - Last Name:TUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:606-261-2050
Mailing Address - Street 1:801 MASTER ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1026
Mailing Address - Country:US
Mailing Address - Phone:606-261-2050
Mailing Address - Fax:
Practice Address - Street 1:801 MASTER ST
Practice Address - Street 2:SUITE #3
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1026
Practice Address - Country:US
Practice Address - Phone:606-261-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY5196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty