Provider Demographics
NPI:1982041505
Name:MUSCULAR THERAPY CLINIC & STRONG HOUSE SPA, INC
Entity Type:Organization
Organization Name:MUSCULAR THERAPY CLINIC & STRONG HOUSE SPA, INC
Other - Org Name:STRONG HOUSE SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:802-295-1718
Mailing Address - Street 1:694 MAIN ST. P.O. BOX 589
Mailing Address - Street 2:
Mailing Address - City:QUECHEE
Mailing Address - State:VT
Mailing Address - Zip Code:05059
Mailing Address - Country:US
Mailing Address - Phone:802-295-1718
Mailing Address - Fax:802-295-3567
Practice Address - Street 1:694 MAIN ST.
Practice Address - Street 2:
Practice Address - City:QUECHEE
Practice Address - State:VT
Practice Address - Zip Code:05059
Practice Address - Country:US
Practice Address - Phone:802-295-1718
Practice Address - Fax:802-295-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH630M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty