Provider Demographics
NPI:1780980722
Name:AVALON MASSAGE & BODY WORKS INC.
Entity type:Organization
Organization Name:AVALON MASSAGE & BODY WORKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-848-0548
Mailing Address - Street 1:430 SUMMERHAVEN DR
Mailing Address - Street 2:300
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2755
Mailing Address - Country:US
Mailing Address - Phone:386-848-0548
Mailing Address - Fax:
Practice Address - Street 1:430 SUMMERHAVEN DR
Practice Address - Street 2:300
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2755
Practice Address - Country:US
Practice Address - Phone:386-848-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty