Provider Demographics
NPI:1851008114
Name:GEORGETOWN PROFESSIONAL MASSAGE AND WELLNESS LLC
Entity Type:Organization
Organization Name:GEORGETOWN PROFESSIONAL MASSAGE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:DEZIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:512-639-2769
Mailing Address - Street 1:4887-1 WILLIAMS DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633
Mailing Address - Country:US
Mailing Address - Phone:512-639-2769
Mailing Address - Fax:
Practice Address - Street 1:4887-1 WILLIAMS DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633
Practice Address - Country:US
Practice Address - Phone:512-639-2769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty