Provider Demographics
NPI:1255151866
Name:AT-EASE THERAPEUTIC MASSAGE
Entity type:Organization
Organization Name:AT-EASE THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:GREIWE
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-669-7634
Mailing Address - Street 1:1907 PASS RD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4101
Mailing Address - Country:US
Mailing Address - Phone:228-207-3355
Mailing Address - Fax:228-233-3668
Practice Address - Street 1:1907 PASS RD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4101
Practice Address - Country:US
Practice Address - Phone:228-207-3355
Practice Address - Fax:228-233-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1417785460OtherOPTUM