Provider Demographics
NPI:1942709324
Name:MASSAGE BY JANA, LLC
Entity Type:Organization
Organization Name:MASSAGE BY JANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:318-729-0278
Mailing Address - Street 1:3834 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3533
Mailing Address - Country:US
Mailing Address - Phone:318-487-0960
Mailing Address - Fax:318-487-2002
Practice Address - Street 1:3834 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3533
Practice Address - Country:US
Practice Address - Phone:318-487-0960
Practice Address - Fax:318-487-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831606664OtherNPI-INDIVIDUAL PROVIDER
LA2759OtherLMT NUMBER