Provider Demographics
NPI:1982071866
Name:ARCHER MASSAGE AND WELLNESS
Entity Type:Organization
Organization Name:ARCHER MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:681-209-4902
Mailing Address - Street 1:98 KRAFT RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-7324
Mailing Address - Country:US
Mailing Address - Phone:681-209-4902
Mailing Address - Fax:
Practice Address - Street 1:6 HARMAN CTR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1559
Practice Address - Country:US
Practice Address - Phone:681-209-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2015-3322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty