Provider Demographics
NPI:1184092850
Name:HEALING RIVERS THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:HEALING RIVERS THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:270-331-3915
Mailing Address - Street 1:890 FAIRVIEW AVE
Mailing Address - Street 2:APARTMENT D112
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4962
Mailing Address - Country:US
Mailing Address - Phone:270-331-3915
Mailing Address - Fax:
Practice Address - Street 1:728 CHESTNUT STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-331-3915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty