Provider Demographics
NPI:1306203492
Name:RAMBLING COWGIRL, LLC
Entity Type:Organization
Organization Name:RAMBLING COWGIRL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORMSBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:810-614-2514
Mailing Address - Street 1:13935 MASTERS RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-2716
Mailing Address - Country:US
Mailing Address - Phone:810-614-2514
Mailing Address - Fax:
Practice Address - Street 1:13935 MASTERS RD
Practice Address - Street 2:
Practice Address - City:ALLENTON
Practice Address - State:MI
Practice Address - Zip Code:48002-2716
Practice Address - Country:US
Practice Address - Phone:810-614-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007462225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty