Provider Demographics
NPI:1821887506
Name:CRE8TIVE MASSAGE, LLC
Entity type:Organization
Organization Name:CRE8TIVE MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:MESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-471-5266
Mailing Address - Street 1:2112 BIENVILLE BLVD STE O1
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2112 BIENVILLE BLVD STE O1
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3069
Practice Address - Country:US
Practice Address - Phone:228-471-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty