Provider Demographics
NPI:1265695175
Name:THERAPEUTIC SKIN CARE AND MASSAGE CENTER
Entity type:Organization
Organization Name:THERAPEUTIC SKIN CARE AND MASSAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPEUTIC SKINCARE AND MASS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:239-481-1111
Mailing Address - Street 1:12951 METRO PARKWAY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1390
Mailing Address - Country:US
Mailing Address - Phone:239-481-1111
Mailing Address - Fax:239-561-8719
Practice Address - Street 1:12951 METRO PARKWAY
Practice Address - Street 2:SUITE 14
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1390
Practice Address - Country:US
Practice Address - Phone:239-481-1111
Practice Address - Fax:239-561-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM19222173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty