Provider Demographics
NPI:1477927077
Name:RECOUP MASSAGE LLC
Entity Type:Organization
Organization Name:RECOUP MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:215-900-4661
Mailing Address - Street 1:12734 DULCINEA PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3122
Mailing Address - Country:US
Mailing Address - Phone:571-336-6113
Mailing Address - Fax:
Practice Address - Street 1:12734 DULCINEA PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3122
Practice Address - Country:US
Practice Address - Phone:571-336-6113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15L04582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty