Organization
CLEANSING WATERS WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN A REYNOLDS L.M.T. (OWNER/MASSAGE THERAPIST)
(256) 314-2328
Entity
Organization
Contact information
Practice address
1300 JOHN R ST, SUITE B, MUSCLE SHOALS, AL 35661-2255
(256) 314-2328
(256) 314-2328
Mailing address
1300 JOHN R ST, SUITE B, MUSCLE SHOALS, AL 35661-2255
(256) 314-2328
(256) 314-2328
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
TX
225700000X
Massage Therapist
Primary
4315
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4315
STATE LICENSE
AL
Enumeration date
09/21/2015
Last updated
09/21/2015
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