Provider Demographics
NPI:1609330984
Name:MASSAGE HARBOR INC.
Entity Type:Organization
Organization Name:MASSAGE HARBOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:831-254-4002
Mailing Address - Street 1:124 MARINA AVE # B
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4515
Mailing Address - Country:US
Mailing Address - Phone:831-278-2868
Mailing Address - Fax:
Practice Address - Street 1:124 MARINA AVE # B
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4515
Practice Address - Country:US
Practice Address - Phone:831-278-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA530394516OtherCAMTC