Provider Demographics
NPI:1750053971
Name:OASIS MOBILE MASSAGE & BODYWORK LLC
Entity Type:Organization
Organization Name:OASIS MOBILE MASSAGE & BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:DURELL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:769-226-1925
Mailing Address - Street 1:119 CLIFF WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-5026
Mailing Address - Country:US
Mailing Address - Phone:769-226-1925
Mailing Address - Fax:
Practice Address - Street 1:5430 EXECUTIVE PL STE 2C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4134
Practice Address - Country:US
Practice Address - Phone:769-226-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty