Provider Demographics
NPI:1558661678
Name:ACUITY THERAPEUTIC MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:ACUITY THERAPEUTIC MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:JESSLYN
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCBTMB
Authorized Official - Phone:850-570-0673
Mailing Address - Street 1:820 E PARK AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2610
Mailing Address - Country:US
Mailing Address - Phone:850-570-0673
Mailing Address - Fax:850-222-9355
Practice Address - Street 1:820 E PARK AVE BLDG A
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2610
Practice Address - Country:US
Practice Address - Phone:850-570-0673
Practice Address - Fax:850-222-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25008174400000X
FLMA57166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC104FOtherBLUE CROSS BLUE SHIELD OF FLORIDA