Provider Demographics
NPI:1669692117
Name:ADVANCED MASSAGE HEALTHCARE, INC.
Entity type:Organization
Organization Name:ADVANCED MASSAGE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:402-423-2643
Mailing Address - Street 1:3601 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-423-2643
Mailing Address - Fax:402-423-2644
Practice Address - Street 1:3601 CALVERT ST
Practice Address - Street 2:34
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5797
Practice Address - Country:US
Practice Address - Phone:402-423-2643
Practice Address - Fax:402-423-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty