Provider Demographics
NPI:1033658737
Name:MASSAGE AT MONROE
Entity Type:Organization
Organization Name:MASSAGE AT MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:GRIER
Authorized Official - Last Name:HAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-491-8329
Mailing Address - Street 1:2325 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-0450
Mailing Address - Country:US
Mailing Address - Phone:704-282-4681
Mailing Address - Fax:
Practice Address - Street 1:2325 HANOVER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0450
Practice Address - Country:US
Practice Address - Phone:704-282-4681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9147405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9147OtherMASSAGE THERAPIST