Provider Demographics
NPI:1689370371
Name:ZEN DEN MASSAGE STUDIO
Entity Type:Organization
Organization Name:ZEN DEN MASSAGE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:912-332-5965
Mailing Address - Street 1:1 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2813
Mailing Address - Country:US
Mailing Address - Phone:912-332-5965
Mailing Address - Fax:
Practice Address - Street 1:1 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2813
Practice Address - Country:US
Practice Address - Phone:912-332-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty