Provider Demographics
NPI:1588672158
Name:IDA OSBORNE
Entity Type:Organization
Organization Name:IDA OSBORNE
Other - Org Name:ATHENS MEDICAL MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:740-594-8796
Mailing Address - Street 1:542 W UNION ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2331
Mailing Address - Country:US
Mailing Address - Phone:740-594-8796
Mailing Address - Fax:740-594-8796
Practice Address - Street 1:542 W UNION ST
Practice Address - Street 2:SUITE 10
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2331
Practice Address - Country:US
Practice Address - Phone:740-594-8796
Practice Address - Fax:740-594-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty