# GREENWAY MASSAGE TEAM, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649461641
- **Authorized official:** MIRRA GREEMWAY LMT, NCBTMB (OWNER)
- **Authorized official phone:** (573) 449-4929

## Contact information

- **Practice address:** 810 E WALNUT ST, COLUMBIA, MO 65201-4863
- **Practice address phone:** (573) 449-4929
- **Practice address fax:** (573) 449-4933
- **Mailing address:** 810 E WALNUT ST, COLUMBIA, MO 65201-4863
- **Mailing address phone:** (573) 449-4929
- **Mailing address fax:** (573) 449-4933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2006005578 | MO | Yes |

## Other

- **Enumeration date:** 08/05/2007
- **Last updated:** 08/14/2007