Provider Demographics
NPI:1376013813
Name:QUALITY THERAPEUTIC MASSAGE LLC
Entity Type:Organization
Organization Name:QUALITY THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:678-612-1051
Mailing Address - Street 1:PO BOX 115294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:678-612-1051
Mailing Address - Fax:
Practice Address - Street 1:423 TAZOR ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2718
Practice Address - Country:US
Practice Address - Phone:678-612-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty