Provider Demographics
NPI:1609032176
Name:PREHAB MASSAGE THERAPY CENTER
Entity Type:Organization
Organization Name:PREHAB MASSAGE THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:615-329-9669
Mailing Address - Street 1:909 18TH AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2102
Mailing Address - Country:US
Mailing Address - Phone:615-329-9669
Mailing Address - Fax:615-329-9393
Practice Address - Street 1:909 18TH AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2102
Practice Address - Country:US
Practice Address - Phone:615-329-9669
Practice Address - Fax:615-329-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty