Provider Demographics
NPI:1891318150
Name:PURE MASSAGE, LLC
Entity Type:Organization
Organization Name:PURE MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:402-980-3657
Mailing Address - Street 1:513 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1207
Mailing Address - Country:US
Mailing Address - Phone:402-980-3657
Mailing Address - Fax:
Practice Address - Street 1:PURE MASSAGE, LLC
Practice Address - Street 2:11316 DAVENPORT ST
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-980-3657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2372OtherNEBRASKA BOARD OF MASSAGE THERAPY
IA094565OtherIOWA BOARD OF MASSAGE THERAPY