Provider Demographics
NPI:1437549524
Name:MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-789-8953
Mailing Address - Street 1:2621 CRABAPPLE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6640
Mailing Address - Country:US
Mailing Address - Phone:561-789-8953
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 35
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4517
Practice Address - Country:US
Practice Address - Phone:561-789-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53020172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty