Provider Demographics
NPI:1871733147
Name:ESSENTIAL ESCAPES
Entity type:Organization
Organization Name:ESSENTIAL ESCAPES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-770-2221
Mailing Address - Street 1:6043 NW 167TH STREET
Mailing Address - Street 2:SUITE A17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4341
Mailing Address - Country:US
Mailing Address - Phone:305-770-2221
Mailing Address - Fax:303-459-7915
Practice Address - Street 1:6043 NW 167TH STREET
Practice Address - Street 2:SUITE A17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-4341
Practice Address - Country:US
Practice Address - Phone:305-770-2221
Practice Address - Fax:303-459-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM21879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty