Provider Demographics
NPI:1942499926
Name:MEDICAL MASSAGE INC
Entity Type:Organization
Organization Name:MEDICAL MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEDOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-536-0767
Mailing Address - Street 1:6681 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5104
Mailing Address - Country:US
Mailing Address - Phone:954-536-0767
Mailing Address - Fax:
Practice Address - Street 1:1912 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5849
Practice Address - Country:US
Practice Address - Phone:954-536-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty