Provider Demographics
NPI:1912139676
Name:DAYTON MEDICAL MASSAGE, LLC
Entity Type:Organization
Organization Name:DAYTON MEDICAL MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:937-271-7072
Mailing Address - Street 1:70 BIRCH ALY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1479
Mailing Address - Country:US
Mailing Address - Phone:937-271-7072
Mailing Address - Fax:937-660-6378
Practice Address - Street 1:70 BIRCH ALY
Practice Address - Street 2:SUITE 240
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-1479
Practice Address - Country:US
Practice Address - Phone:937-271-7072
Practice Address - Fax:937-660-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33. 016347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty