Provider Demographics
NPI:1063820538
Name:THERAPEUTIC MASSAGE GROUP AND EQUIPMENT
Entity Type:Organization
Organization Name:THERAPEUTIC MASSAGE GROUP AND EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLOES
Authorized Official - Suffix:
Authorized Official - Credentials:MMP
Authorized Official - Phone:316-706-6965
Mailing Address - Street 1:10500 E BERKELEY SQUARE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-6815
Mailing Address - Country:US
Mailing Address - Phone:316-706-6965
Mailing Address - Fax:
Practice Address - Street 1:2504 E GLEN OAKS CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-2215
Practice Address - Country:US
Practice Address - Phone:316-706-6965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS22Other22
KS225700000XOther22