Provider Demographics
NPI:1740569045
Name:HOUR OF BLISS MASSAGE THERAPY
Entity type:Organization
Organization Name:HOUR OF BLISS MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MOWERY
Authorized Official - Last Name:DIZOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT MA55833
Authorized Official - Phone:904-379-0887
Mailing Address - Street 1:6349 103RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7734
Mailing Address - Country:US
Mailing Address - Phone:904-379-0887
Mailing Address - Fax:904-379-0086
Practice Address - Street 1:6349 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7734
Practice Address - Country:US
Practice Address - Phone:904-379-0887
Practice Address - Fax:904-379-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty