Provider Demographics
NPI:1841807906
Name:12 HOUR MASSAGE 2 LLC
Entity type:Organization
Organization Name:12 HOUR MASSAGE 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER & LMT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:COCO
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:337-302-1675
Mailing Address - Street 1:3113 RYAN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8587
Mailing Address - Country:US
Mailing Address - Phone:337-802-9631
Mailing Address - Fax:
Practice Address - Street 1:3113 RYAN ST STE 6
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8587
Practice Address - Country:US
Practice Address - Phone:337-802-9631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty