Provider Demographics
NPI:1932524741
Name:MUSCLE SOLACE LLC
Entity Type:Organization
Organization Name:MUSCLE SOLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MEDICAL MASSAGE PRACTITIONE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:209-912-9095
Mailing Address - Street 1:715 VAN EMBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-3816
Mailing Address - Country:US
Mailing Address - Phone:209-912-9095
Mailing Address - Fax:
Practice Address - Street 1:715 VAN EMBURGH AVE
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-3816
Practice Address - Country:US
Practice Address - Phone:209-912-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00528600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty