Provider Demographics
NPI:1447663513
Name:DANVILLE THERAPEUTIC MASSAGE
Entity type:Organization
Organization Name:DANVILLE THERAPEUTIC MASSAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:859-319-4399
Mailing Address - Street 1:474 WHIRLAWAY DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9037
Mailing Address - Country:US
Mailing Address - Phone:859-319-4399
Mailing Address - Fax:
Practice Address - Street 1:318 N 6TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1245
Practice Address - Country:US
Practice Address - Phone:859-319-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY5136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty