Provider Demographics
NPI:1497531487
Name:MASSAGE THERAPY OF OZARK, LLC
Entity Type:Organization
Organization Name:MASSAGE THERAPY OF OZARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:O
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT/LMT
Authorized Official - Phone:334-618-1494
Mailing Address - Street 1:1394 S US HIGHWAY 231 STE 1
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-4412
Mailing Address - Country:US
Mailing Address - Phone:334-443-1004
Mailing Address - Fax:
Practice Address - Street 1:1394 S US HIGHWAY 231 STE 1
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-4412
Practice Address - Country:US
Practice Address - Phone:334-443-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty