Provider Demographics
NPI:1811342546
Name:ALIGN TOTAL WELLNESS
Entity type:Organization
Organization Name:ALIGN TOTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRONDA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-415-9421
Mailing Address - Street 1:332 W BROADWAY
Mailing Address - Street 2:207
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2130
Mailing Address - Country:US
Mailing Address - Phone:502-415-9421
Mailing Address - Fax:
Practice Address - Street 1:332 W BROADWAY
Practice Address - Street 2:#207
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-415-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty