Provider Demographics
NPI:1235552753
Name:MASSAGE INDY
Entity Type:Organization
Organization Name:MASSAGE INDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:SHONN
Authorized Official - Last Name:PIERSOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-721-9321
Mailing Address - Street 1:11519 ALLISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1848
Mailing Address - Country:US
Mailing Address - Phone:317-721-9321
Mailing Address - Fax:
Practice Address - Street 1:11519 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1848
Practice Address - Country:US
Practice Address - Phone:317-721-9321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty