Provider Demographics
NPI:1124549167
Name:M.E. MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:M.E. MASSAGE THERAPY, LLC
Other - Org Name:M.E. MASSGE THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGECOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:207-240-6415
Mailing Address - Street 1:185 WEBSTER ST STE 14A
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5500
Mailing Address - Country:US
Mailing Address - Phone:207-240-6415
Mailing Address - Fax:
Practice Address - Street 1:185 WEBSTER ST STE 14A
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-240-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization