Provider Demographics
NPI:1457106890
Name:MINERAL AREA MASSAGE LLC
Entity type:Organization
Organization Name:MINERAL AREA MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CAMDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:573-430-9963
Mailing Address - Street 1:1148 STATE HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-8207
Mailing Address - Country:US
Mailing Address - Phone:573-430-9963
Mailing Address - Fax:
Practice Address - Street 1:301 N WASHINGTON ST STE 6
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1750
Practice Address - Country:US
Practice Address - Phone:573-430-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty