Organization
MYTHIC MASSAGE LLC
Active
Organization
MYTHIC MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEWW GOMEZ LMBT (OWNER)
(704) 323-6718
Entity
Organization
Contact information
Practice address
5701 EXECUTIVE CENTER DR STE 350, CHARLOTTE, NC 28212-8847
(704) 323-6718
Mailing address
5701 EXECUTIVE CENTER DR STE 350, CHARLOTTE, NC 28212-8847
(704) 323-6718
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
06/03/2020
Last updated
11/08/2023
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