Provider Demographics
NPI:1235990672
Name:RESTORE MASSAGE
Entity Type:Organization
Organization Name:RESTORE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE/ MASSAGE THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:DELIA
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MTI ,MT
Authorized Official - Phone:210-689-2222
Mailing Address - Street 1:615 CLAUDE W BLACK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78203-1400
Mailing Address - Country:US
Mailing Address - Phone:210-689-2222
Mailing Address - Fax:
Practice Address - Street 1:8000 W INTERSTATE 10 STE 673
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3868
Practice Address - Country:US
Practice Address - Phone:210-689-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty