Provider Demographics
NPI:1801271861
Name:INFORMED TOUCH MASSAGE THERAPY
Entity type:Organization
Organization Name:INFORMED TOUCH MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, C-PT
Authorized Official - Phone:302-229-8239
Mailing Address - Street 1:905 IBIZA CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-3052
Mailing Address - Country:US
Mailing Address - Phone:302-229-8239
Mailing Address - Fax:
Practice Address - Street 1:905 IBIZA CT
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-3052
Practice Address - Country:US
Practice Address - Phone:302-229-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0002666302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization