Provider Demographics
NPI:1184195182
Name:DEEP TISSUE MASSAGE GROUP, INC.
Entity type:Organization
Organization Name:DEEP TISSUE MASSAGE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:406-493-1115
Mailing Address - Street 1:725 W ALDER ST STE 20
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4099
Mailing Address - Country:US
Mailing Address - Phone:406-493-1115
Mailing Address - Fax:
Practice Address - Street 1:725 W ALDER ST STE 20
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4099
Practice Address - Country:US
Practice Address - Phone:406-493-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty