Provider Demographics
NPI:1760831705
Name:NOSTALGIC PLIGHT LIVE LLC
Entity Type:Organization
Organization Name:NOSTALGIC PLIGHT LIVE LLC
Other - Org Name:HOLISTIC HEALTH LMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:614-707-9887
Mailing Address - Street 1:144 E OLENTANGY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9069
Mailing Address - Country:US
Mailing Address - Phone:614-547-9355
Mailing Address - Fax:
Practice Address - Street 1:144 E OLENTANGY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9069
Practice Address - Country:US
Practice Address - Phone:614-547-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.021127225700000X, 225700000X
OH33.015276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty