Provider Demographics
NPI:1851604912
Name:THERAPEUTIC MASSAGE CARE
Entity Type:Organization
Organization Name:THERAPEUTIC MASSAGE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:859-734-4325
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-0121
Mailing Address - Country:US
Mailing Address - Phone:859-734-4325
Mailing Address - Fax:
Practice Address - Street 1:125 HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-9113
Practice Address - Country:US
Practice Address - Phone:859-734-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty