Provider Demographics
NPI:1326669987
Name:GORGEWORKS MASSAGE & FITNESS, LLC
Entity Type:Organization
Organization Name:GORGEWORKS MASSAGE & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:304-640-3642
Mailing Address - Street 1:4397 OPOSSUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:WV
Mailing Address - Zip Code:25862-6223
Mailing Address - Country:US
Mailing Address - Phone:304-640-3642
Mailing Address - Fax:
Practice Address - Street 1:325 JONES AVENUE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2908
Practice Address - Country:US
Practice Address - Phone:304-465-4325
Practice Address - Fax:304-465-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty