Provider Demographics
NPI:1275946949
Name:INTUITIVE MASSAGE, INC.
Entity Type:Organization
Organization Name:INTUITIVE MASSAGE, INC.
Other - Org Name:INTUITIVE MASSAGE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NIKOLAKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:863-402-2208
Mailing Address - Street 1:943 MALL RING RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8515
Mailing Address - Country:US
Mailing Address - Phone:863-402-2208
Mailing Address - Fax:
Practice Address - Street 1:943 MALL RING RD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8515
Practice Address - Country:US
Practice Address - Phone:863-402-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2428171100000X
FLMA40195225700000X
FLMA73340225700000X
FLMA27257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty