Provider Demographics
NPI:1568800944
Name:WHOLISTICKNEADS MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:WHOLISTICKNEADS MASSAGE THERAPY, LLC
Other - Org Name:ADVANCED ORIENTAL MEDICINE (ADVANCEDOM)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZUBLIONIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, AP
Authorized Official - Phone:386-503-8511
Mailing Address - Street 1:2 PINE LAKES PKWY N STE 7
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3644
Mailing Address - Country:US
Mailing Address - Phone:386-264-6781
Mailing Address - Fax:
Practice Address - Street 1:2 PINE LAKES PKWY N STE 7
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3644
Practice Address - Country:US
Practice Address - Phone:386-503-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 225700000X
FLMA46287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty