Provider Demographics
NPI:1245413509
Name:MASSAGE THERAPY WORX
Entity Type:Organization
Organization Name:MASSAGE THERAPY WORX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DISNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RMT,LMT,NCTMB
Authorized Official - Phone:662-536-2220
Mailing Address - Street 1:728 GOODMAN RD E
Mailing Address - Street 2:STE 3
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9530
Mailing Address - Country:US
Mailing Address - Phone:662-536-2220
Mailing Address - Fax:662-536-2221
Practice Address - Street 1:728 GOODMAN RD E
Practice Address - Street 2:STE 3
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9530
Practice Address - Country:US
Practice Address - Phone:662-536-2220
Practice Address - Fax:662-536-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1021251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management