Provider Demographics
NPI:1073704698
Name:FAMILY MASSAGE CENTER, INC
Entity Type:Organization
Organization Name:FAMILY MASSAGE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:727-712-3926
Mailing Address - Street 1:132 10TH AVE N
Mailing Address - Street 2:105
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3407
Mailing Address - Country:US
Mailing Address - Phone:727-712-3926
Mailing Address - Fax:727-723-3160
Practice Address - Street 1:132 10TH AVE N
Practice Address - Street 2:105
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3407
Practice Address - Country:US
Practice Address - Phone:727-712-3926
Practice Address - Fax:727-723-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0004500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5099OtherBLUE CROSS BLUE SHIELD