Provider Demographics
NPI:1184810160
Name:PALM BEACH MASSAGE THERAPY, INC
Entity type:Organization
Organization Name:PALM BEACH MASSAGE THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KONIDARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-844-6777
Mailing Address - Street 1:653 FAIRWIND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4302
Mailing Address - Country:US
Mailing Address - Phone:561-844-6777
Mailing Address - Fax:561-841-1618
Practice Address - Street 1:13860 WELLINGTON TRCE
Practice Address - Street 2:SUITE #13
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8588
Practice Address - Country:US
Practice Address - Phone:561-844-6777
Practice Address - Fax:561-841-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7029261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center