Provider Demographics
NPI:1629314034
Name:CORBIN MASSAGE THERAPY
Entity Type:Organization
Organization Name:CORBIN MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:606-258-1995
Mailing Address - Street 1:1805 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2405
Mailing Address - Country:US
Mailing Address - Phone:606-258-1995
Mailing Address - Fax:606-258-1996
Practice Address - Street 1:1805 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2405
Practice Address - Country:US
Practice Address - Phone:606-258-1995
Practice Address - Fax:606-258-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty