Provider Demographics
NPI:1396004016
Name:AWARENESS MASSAGE AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:AWARENESS MASSAGE AND WELLNESS CENTER, LLC
Other - Org Name:AWARENESS MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:REIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:440-231-3824
Mailing Address - Street 1:8060 DARTMOOR RD
Mailing Address - Street 2:STE. 306A
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7609
Mailing Address - Country:US
Mailing Address - Phone:440-231-3824
Mailing Address - Fax:
Practice Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6700
Practice Address - Country:US
Practice Address - Phone:440-231-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH018631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty