Provider Demographics
NPI:1306226766
Name:TOTAL RELAXATION THERAPEUTIC MASSAGE SPA LLC
Entity Type:Organization
Organization Name:TOTAL RELAXATION THERAPEUTIC MASSAGE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREWS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-300-7859
Mailing Address - Street 1:7710 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2979
Mailing Address - Country:US
Mailing Address - Phone:612-293-7142
Mailing Address - Fax:763-226-2512
Practice Address - Street 1:7710 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2979
Practice Address - Country:US
Practice Address - Phone:612-293-7142
Practice Address - Fax:763-226-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty