Provider Demographics
NPI:1669283024
Name:TAJ MASSAGE THERAPY
Entity type:Organization
Organization Name:TAJ MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-662-8379
Mailing Address - Street 1:10464 ZACH RD
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4712
Mailing Address - Country:US
Mailing Address - Phone:706-662-8379
Mailing Address - Fax:
Practice Address - Street 1:1852 TRAWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3106
Practice Address - Country:US
Practice Address - Phone:915-343-0699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNIE DAVIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-15
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty