Provider Demographics
NPI: | 1710455530 |
---|---|
Name: | ESCAPE AWAY MASSAGE |
Entity Type: | Organization |
Organization Name: | ESCAPE AWAY MASSAGE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | GENERAL MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DANIELLE |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | BARRES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 315-941-1895 |
Mailing Address - Street 1: | 587 MAIN ST STE 202 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK MILLS |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 13417-1489 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 315-768-1155 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 587 MAIN ST STE 202 |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK MILLS |
Practice Address - State: | NY |
Practice Address - Zip Code: | 13417-1489 |
Practice Address - Country: | US |
Practice Address - Phone: | 315-768-1155 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CARBONE ATHLETICS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-11-09 |
Last Update Date: | 2018-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Single Specialty |