Provider Demographics
NPI:1376728154
Name:MASSAGE THERAPEUTICS, INC CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:MASSAGE THERAPEUTICS, INC CENTER FOR WELLNESS
Other - Org Name:URSULA J. EDWARDS ELLERBY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/NEUROMUSCULAR THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:JACINTA
Authorized Official - Last Name:EDWARDS ELLERBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT
Authorized Official - Phone:404-765-0798
Mailing Address - Street 1:8299 DEWAYNE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3710
Mailing Address - Country:US
Mailing Address - Phone:404-765-0798
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 411
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7638
Practice Address - Country:US
Practice Address - Phone:404-765-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-30
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003516261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center