Provider Demographics
NPI:1770969032
Name:SIMPLE MASSAAGE, LLC
Entity type:Organization
Organization Name:SIMPLE MASSAAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:480-525-7322
Mailing Address - Street 1:3709 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5015
Mailing Address - Country:US
Mailing Address - Phone:480-525-7322
Mailing Address - Fax:
Practice Address - Street 1:3709 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5015
Practice Address - Country:US
Practice Address - Phone:480-525-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT08021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty