Provider Demographics
NPI:1205231420
Name:ALLAY INTEGRATIVE MASSAGE THERAPY CENTER LLC
Entity Type:Organization
Organization Name:ALLAY INTEGRATIVE MASSAGE THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:334-701-9332
Mailing Address - Street 1:2543 ROSS CLARK CIR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4925
Mailing Address - Country:US
Mailing Address - Phone:334-701-9332
Mailing Address - Fax:334-699-1308
Practice Address - Street 1:2543 ROSS CLARK CIR
Practice Address - Street 2:SUITE #4
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4925
Practice Address - Country:US
Practice Address - Phone:334-701-9332
Practice Address - Fax:334-699-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1548664568OtherINDIVIDUAL NPI