Provider Demographics
NPI:1598399156
Name:PAMPERED BY ME MOBILE MASSAGE
Entity Type:Organization
Organization Name:PAMPERED BY ME MOBILE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MATTHIS
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:916-544-7018
Mailing Address - Street 1:3341 MONO WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-2032
Mailing Address - Country:US
Mailing Address - Phone:916-544-7018
Mailing Address - Fax:
Practice Address - Street 1:3341 MONO WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-2032
Practice Address - Country:US
Practice Address - Phone:916-544-7018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty