Provider Demographics
NPI:1245055268
Name:DIVINE TOUCH MASSAGE THERAPY, LLC
Entity type:Organization
Organization Name:DIVINE TOUCH MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARESTSA
Authorized Official - Middle Name:SHONTA
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:910-300-9230
Mailing Address - Street 1:354 WAGONER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4659
Mailing Address - Country:US
Mailing Address - Phone:910-300-9230
Mailing Address - Fax:
Practice Address - Street 1:354 WAGONER DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4659
Practice Address - Country:US
Practice Address - Phone:910-300-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty