Provider Demographics
NPI:1679106850
Name:HEALTHY KNEADS MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:HEALTHY KNEADS MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:419-340-2704
Mailing Address - Street 1:PO BOX 2578
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-0578
Mailing Address - Country:US
Mailing Address - Phone:419-340-2704
Mailing Address - Fax:
Practice Address - Street 1:5810 SOUTHWYCK BLVD STE 100E
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1514
Practice Address - Country:US
Practice Address - Phone:419-340-2704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service