Provider Demographics
NPI:1316204522
Name:LOW COUNTRY MASSAGE & WELLNESS, LLC
Entity Type:Organization
Organization Name:LOW COUNTRY MASSAGE & WELLNESS, LLC
Other - Org Name:LOWCOUNTRY DAY SPA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BLAKELY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:843-543-1113
Mailing Address - Street 1:1036 MOUNT ZION AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-4823
Mailing Address - Country:US
Mailing Address - Phone:843-543-1113
Mailing Address - Fax:
Practice Address - Street 1:1036 MOUNT ZION AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4823
Practice Address - Country:US
Practice Address - Phone:843-543-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6530302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization