Provider Demographics
NPI:1841696804
Name:JAVINTE MASSAGE
Entity type:Organization
Organization Name:JAVINTE MASSAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KELSO- WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-514-6055
Mailing Address - Street 1:6801 RUFE SNOW DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2348
Mailing Address - Country:US
Mailing Address - Phone:817-514-6055
Mailing Address - Fax:
Practice Address - Street 1:6801 RUFE SNOW DR
Practice Address - Street 2:SUITE 404
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2348
Practice Address - Country:US
Practice Address - Phone:817-514-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center