Provider Demographics
NPI:1780281097
Name:LIVING HEALTHY MASSAGE INC.
Entity type:Organization
Organization Name:LIVING HEALTHY MASSAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA65820
Authorized Official - Phone:352-817-8823
Mailing Address - Street 1:6749 NW 62ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-8443
Mailing Address - Country:US
Mailing Address - Phone:352-817-8823
Mailing Address - Fax:
Practice Address - Street 1:6749 NW 62ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-8443
Practice Address - Country:US
Practice Address - Phone:352-817-8823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty