Provider Demographics
NPI:1265803191
Name:INTEGRATIVE MASSAGE CONCEPTS OF CHARLOTTE,INC
Entity type:Organization
Organization Name:INTEGRATIVE MASSAGE CONCEPTS OF CHARLOTTE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSCHUETZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCTMB,LMBT#4478,CLT
Authorized Official - Phone:704-904-1462
Mailing Address - Street 1:6747 FAIRVIEW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3354
Mailing Address - Country:US
Mailing Address - Phone:704-904-1462
Mailing Address - Fax:704-364-4377
Practice Address - Street 1:6747 FAIRVIEW RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3354
Practice Address - Country:US
Practice Address - Phone:704-904-1462
Practice Address - Fax:704-364-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMBT#4478172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty