Organization
JUST KNEAD MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M LUCKOW LMT (OWNER/LMT)
(920) 901-8044
Entity
Organization
Contact information
Practice address
210 N 8TH ST, MANITOWOC, WI 54220-4606
(920) 901-8044
Mailing address
5827 LUCKOW LN, MANITOWOC, WI 54220-9555
(920) 901-8044
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
601661-11
NCBTMB
WI
Enumeration date
09/13/2021
Last updated
09/13/2021
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