Provider Demographics
NPI:1710359146
Name:CARISSA RESSLER LLC
Entity Type:Organization
Organization Name:CARISSA RESSLER LLC
Other - Org Name:KAIROS MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CPT, CIMTI
Authorized Official - Phone:717-824-6428
Mailing Address - Street 1:8 EAST HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022
Mailing Address - Country:US
Mailing Address - Phone:717-617-7779
Mailing Address - Fax:
Practice Address - Street 1:8 EAST HIGH STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022
Practice Address - Country:US
Practice Address - Phone:717-617-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005108225700000X
PAMSG000868225700000X
PAMSG008533225700000X
PAMSG005928225700000X
PAMSG010099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty