Provider Demographics
NPI:1033688940
Name:DOTHAN MASSAGE SCHOOL
Entity Type:Organization
Organization Name:DOTHAN MASSAGE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-439-0262
Mailing Address - Street 1:104 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9348
Mailing Address - Country:US
Mailing Address - Phone:334-439-0262
Mailing Address - Fax:
Practice Address - Street 1:1558 MONTGOMERY HWY STE 7
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3300
Practice Address - Country:US
Practice Address - Phone:334-439-0262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty