Provider Demographics
NPI:1508095274
Name:ALTERNATIVE HEALTH MASSAGE & BODYWORK INC,
Entity Type:Organization
Organization Name:ALTERNATIVE HEALTH MASSAGE & BODYWORK INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MERCY
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCTMB, CR
Authorized Official - Phone:239-784-9309
Mailing Address - Street 1:SOUTH COLLIER BOULEVARD
Mailing Address - Street 2:685
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145
Mailing Address - Country:US
Mailing Address - Phone:239-393-0893
Mailing Address - Fax:
Practice Address - Street 1:SOUTH COLLIER BOULEVARD
Practice Address - Street 2:685
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145
Practice Address - Country:US
Practice Address - Phone:239-393-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM16853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty