Provider Demographics
NPI:1851515001
Name:LEBANON MASSAGE THERAPEUTICS, INC.
Entity Type:Organization
Organization Name:LEBANON MASSAGE THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:270-699-9949
Mailing Address - Street 1:125 E M L KING AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1550
Mailing Address - Country:US
Mailing Address - Phone:270-699-9949
Mailing Address - Fax:270-699-2424
Practice Address - Street 1:125 E M L KING AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1550
Practice Address - Country:US
Practice Address - Phone:270-699-9949
Practice Address - Fax:270-699-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty