Provider Demographics
NPI:1801104294
Name:INFINITE WEILLNESS INC
Entity type:Organization
Organization Name:INFINITE WEILLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:386-423-5585
Mailing Address - Street 1:821 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6938
Mailing Address - Country:US
Mailing Address - Phone:386-423-5585
Mailing Address - Fax:386-409-0205
Practice Address - Street 1:821 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6938
Practice Address - Country:US
Practice Address - Phone:386-423-5585
Practice Address - Fax:386-409-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA46324OtherSTATE OF FLORIDA MASSAGE LICENSE