Provider Demographics
NPI:1689285256
Name:NURTURED MASSAGE, LLC
Entity Type:Organization
Organization Name:NURTURED MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MORIYA
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-226-2346
Mailing Address - Street 1:1330 NW 6TH ST STE D-1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2211
Mailing Address - Country:US
Mailing Address - Phone:352-226-2346
Mailing Address - Fax:
Practice Address - Street 1:1330 NW 6TH ST STE D-1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2211
Practice Address - Country:US
Practice Address - Phone:352-226-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty