Provider Demographics
NPI:1629520069
Name:A HEALING EXPERIENCE, LLC
Entity Type:Organization
Organization Name:A HEALING EXPERIENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WESTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMT
Authorized Official - Phone:941-704-8326
Mailing Address - Street 1:5911 WILLOWS BRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-5218
Mailing Address - Country:US
Mailing Address - Phone:941-704-8326
Mailing Address - Fax:
Practice Address - Street 1:5911 WILLOWS BRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-5218
Practice Address - Country:US
Practice Address - Phone:941-704-8326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care