Provider Demographics
NPI:1952590374
Name:CRESCENT MASSAGE AND WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:CRESCENT MASSAGE AND WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:813-333-6521
Mailing Address - Street 1:2635 WINDGUARD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7356
Mailing Address - Country:US
Mailing Address - Phone:813-333-6521
Mailing Address - Fax:813-435-2012
Practice Address - Street 1:2635 WINDGUARD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7356
Practice Address - Country:US
Practice Address - Phone:813-333-6521
Practice Address - Fax:813-435-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty