Provider Demographics
NPI:1790939007
Name:FAMILY THERAPEUTIC MASSAGE GROUP, INC.
Entity Type:Organization
Organization Name:FAMILY THERAPEUTIC MASSAGE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:405-735-8497
Mailing Address - Street 1:13316 SUITE O S. WESTERN
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73170
Mailing Address - Country:US
Mailing Address - Phone:405-735-8497
Mailing Address - Fax:405-735-8450
Practice Address - Street 1:13316 SUITE O S. WESTERN
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-735-8497
Practice Address - Fax:405-735-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKBUS08783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty