Provider Demographics
NPI:1871820829
Name:BACK-N-ACTION THERAPEUTIC MASSAGE, LLC
Entity Type:Organization
Organization Name:BACK-N-ACTION THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:602-697-7828
Mailing Address - Street 1:8228 W PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2223
Mailing Address - Country:US
Mailing Address - Phone:602-697-7828
Mailing Address - Fax:
Practice Address - Street 1:8228 W PALMAIRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-2223
Practice Address - Country:US
Practice Address - Phone:602-697-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-04739P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty