Provider Demographics
NPI:1124209788
Name:BAY MASSAGE THERAPY INC
Entity Type:Organization
Organization Name:BAY MASSAGE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JERMYN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:850-769-7786
Mailing Address - Street 1:1714 WEST 23RD STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-769-7786
Mailing Address - Fax:850-769-8689
Practice Address - Street 1:1714 WEST 23RD STREET
Practice Address - Street 2:SUITE E
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-769-7786
Practice Address - Fax:850-769-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0024837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty