Provider Demographics
NPI:1164691002
Name:MASSOTHERAPY REHABILITATION CLINIC INC.
Entity Type:Organization
Organization Name:MASSOTHERAPY REHABILITATION CLINIC INC.
Other - Org Name:ACUPUNCTCHI CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAMED
Authorized Official - Suffix:
Authorized Official - Credentials:RAC,LMT,CHT
Authorized Official - Phone:216-381-9995
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-381-9995
Mailing Address - Fax:440-551-8179
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 503
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-381-9995
Practice Address - Fax:440-551-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000093171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty