Provider Demographics
NPI:1497519771
Name:ASCENSION MASSAGE BY MELINDA
Entity Type:Organization
Organization Name:ASCENSION MASSAGE BY MELINDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:863-860-1408
Mailing Address - Street 1:255 N KENTUCKY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4981
Mailing Address - Country:US
Mailing Address - Phone:863-860-1408
Mailing Address - Fax:
Practice Address - Street 1:255 N KENTUCKY AVE STE 301
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4981
Practice Address - Country:US
Practice Address - Phone:863-860-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty