Provider Demographics
NPI:1235958885
Name:STRETCHUSOON
Entity type:Organization
Organization Name:STRETCHUSOON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DESTINEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-536-4112
Mailing Address - Street 1:1800 JONESBORO RD SE # G9
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5314
Mailing Address - Country:US
Mailing Address - Phone:404-536-4112
Mailing Address - Fax:
Practice Address - Street 1:1800 JONESBORO RD SE # G9
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5314
Practice Address - Country:US
Practice Address - Phone:404-536-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty