Provider Demographics
NPI:1629476528
Name:SMITH MASSAGE THERAPY
Entity Type:Organization
Organization Name:SMITH MASSAGE THERAPY
Other - Org Name:SMITH MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:925-812-0344
Mailing Address - Street 1:191 SAND CREEK RD
Mailing Address - Street 2:SUITE 202-B
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2215
Mailing Address - Country:US
Mailing Address - Phone:925-812-0344
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD
Practice Address - Street 2:SUITE 202-B
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2215
Practice Address - Country:US
Practice Address - Phone:925-812-0344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty