Provider Demographics
NPI:1770826067
Name:AZ MASSAGE SPA
Entity Type:Organization
Organization Name:AZ MASSAGE SPA
Other - Org Name:JESSE JAMES BODY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-573-1309
Mailing Address - Street 1:44 W MONROE ST
Mailing Address - Street 2:APT 1401
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-4553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 W MONROE ST
Practice Address - Street 2:APT 1401
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-4553
Practice Address - Country:US
Practice Address - Phone:602-573-1309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-04127P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty