Provider Demographics
NPI:1760522726
Name:APPALACHIAN MEDICAL MASSAGE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:APPALACHIAN MEDICAL MASSAGE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:NCMMT
Authorized Official - Phone:423-288-2662
Mailing Address - Street 1:317 CHEROKEE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4335
Mailing Address - Country:US
Mailing Address - Phone:423-288-2662
Mailing Address - Fax:423-245-7863
Practice Address - Street 1:317 CHEROKEE ST STE 101
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4335
Practice Address - Country:US
Practice Address - Phone:423-288-2662
Practice Address - Fax:423-245-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1869261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty