Provider Demographics
NPI:1073195616
Name:MASSAGE GODDESS LLC
Entity Type:Organization
Organization Name:MASSAGE GODDESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MEDICAL MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:213-807-6002
Mailing Address - Street 1:9841 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2523
Mailing Address - Country:US
Mailing Address - Phone:213-807-6002
Mailing Address - Fax:
Practice Address - Street 1:9841 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2523
Practice Address - Country:US
Practice Address - Phone:213-807-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service