Provider Demographics
NPI:1326449604
Name:SOUL TO SOUL MASSAGE LLC
Entity Type:Organization
Organization Name:SOUL TO SOUL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-507-0412
Mailing Address - Street 1:100 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WI
Mailing Address - Zip Code:54479-9508
Mailing Address - Country:US
Mailing Address - Phone:715-507-0412
Mailing Address - Fax:
Practice Address - Street 1:604 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4511
Practice Address - Country:US
Practice Address - Phone:715-507-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service