Provider Demographics
NPI:1578913067
Name:MYO-MY MASSAGE AND FITNESS CAFE, LLC
Entity Type:Organization
Organization Name:MYO-MY MASSAGE AND FITNESS CAFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-906-5271
Mailing Address - Street 1:1803 TAMARRON PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12075 HAVANA RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-4508
Practice Address - Country:US
Practice Address - Phone:770-906-5271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty