Provider Demographics
NPI:1568707313
Name:KNOW KNOTS MASSAGE
Entity Type:Organization
Organization Name:KNOW KNOTS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JEAGER
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:III
Authorized Official - Credentials:CMT
Authorized Official - Phone:951-581-3242
Mailing Address - Street 1:52 ROUND TABLE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6998
Mailing Address - Country:US
Mailing Address - Phone:951-581-3242
Mailing Address - Fax:951-213-6761
Practice Address - Street 1:8052 LIMONITE AVE
Practice Address - Street 2:STE 104
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6124
Practice Address - Country:US
Practice Address - Phone:951-581-3242
Practice Address - Fax:951-213-6761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty