Provider Demographics
NPI:1164765780
Name:KNEAD A MASSAGE, LLC
Entity Type:Organization
Organization Name:KNEAD A MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-697-0959
Mailing Address - Street 1:450 SHEPARD DR
Mailing Address - Street 2:SUITE #7
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7033
Mailing Address - Country:US
Mailing Address - Phone:630-697-0959
Mailing Address - Fax:
Practice Address - Street 1:450 SHEPARD DR
Practice Address - Street 2:SUITE #7
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7033
Practice Address - Country:US
Practice Address - Phone:630-697-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty