Provider Demographics
NPI:1902221385
Name:THERAPEUTIC & PAIN MANAGEMENT MASSAGE THERAPY
Entity Type:Organization
Organization Name:THERAPEUTIC & PAIN MANAGEMENT MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP
Authorized Official - Phone:270-893-8706
Mailing Address - Street 1:105 ROBINS WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1129
Mailing Address - Country:US
Mailing Address - Phone:270-893-8706
Mailing Address - Fax:888-704-8506
Practice Address - Street 1:105 ROBINS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1129
Practice Address - Country:US
Practice Address - Phone:270-893-8706
Practice Address - Fax:888-704-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty