Provider Demographics
NPI:1972893378
Name:LOTUS BLOSSOM ORIENTAL MASSAGE, INC
Entity Type:Organization
Organization Name:LOTUS BLOSSOM ORIENTAL MASSAGE, INC
Other - Org Name:LOTUS BLOSSOM MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-674-7986
Mailing Address - Street 1:10249 S JOHN YOUNG PKWY
Mailing Address - Street 2:UNIT 106
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4022
Mailing Address - Country:US
Mailing Address - Phone:407-674-7986
Mailing Address - Fax:407-674-7987
Practice Address - Street 1:10249 S JOHN YOUNG PKWY
Practice Address - Street 2:UNIT 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4022
Practice Address - Country:US
Practice Address - Phone:407-674-7986
Practice Address - Fax:407-674-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty