Provider Demographics
NPI:1669234415
Name:MASSAGE IN BROOKFIELD AREA
Entity type:Organization
Organization Name:MASSAGE IN BROOKFIELD AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-478-7085
Mailing Address - Street 1:4040 N CALHOUN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1341
Mailing Address - Country:US
Mailing Address - Phone:262-478-7085
Mailing Address - Fax:
Practice Address - Street 1:4040 N CALHOUN RD STE 105
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1341
Practice Address - Country:US
Practice Address - Phone:262-478-7085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty