Provider Demographics
NPI:1215558556
Name:MARYVILLE MASSAGE
Entity Type:Organization
Organization Name:MARYVILLE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:865-801-5551
Mailing Address - Street 1:1056 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3569
Mailing Address - Country:US
Mailing Address - Phone:865-801-5551
Mailing Address - Fax:
Practice Address - Street 1:1056 WILLOW CREEK CIR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3569
Practice Address - Country:US
Practice Address - Phone:865-801-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty