Provider Demographics
NPI:1073069191
Name:MA' THERAPY (MASSAGE SPA CLINIC)
Entity Type:Organization
Organization Name:MA' THERAPY (MASSAGE SPA CLINIC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ L.M.T.
Authorized Official - Prefix:
Authorized Official - First Name:TAMALA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:850-426-4158
Mailing Address - Street 1:4600 TWIN OAKS DR
Mailing Address - Street 2:101
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6637
Mailing Address - Country:US
Mailing Address - Phone:850-426-4158
Mailing Address - Fax:
Practice Address - Street 1:4600 TWIN OAKS DR
Practice Address - Street 2:101
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6637
Practice Address - Country:US
Practice Address - Phone:850-426-4158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62968302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization