Provider Demographics
NPI:1578007985
Name:BARKDOLL MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:BARKDOLL MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:727-372-6389
Mailing Address - Street 1:1754 BOCAWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4908
Mailing Address - Country:US
Mailing Address - Phone:727-372-6389
Mailing Address - Fax:
Practice Address - Street 1:1754 BOCAWOOD CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4908
Practice Address - Country:US
Practice Address - Phone:727-372-6389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty