Provider Demographics
NPI:1164101275
Name:LEAVE AT EASE MASSAGE
Entity Type:Organization
Organization Name:LEAVE AT EASE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MT
Authorized Official - Phone:629-215-0345
Mailing Address - Street 1:3234 CROWE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-3104
Mailing Address - Country:US
Mailing Address - Phone:629-215-0345
Mailing Address - Fax:
Practice Address - Street 1:3234 CROWE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-3104
Practice Address - Country:US
Practice Address - Phone:615-854-7434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAVE AT EASE MASSAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty