Organization
STILL WATERS MSSSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLIE VICTORIA KING LMT (LICENSED MASSAGE THERPIST)
(334) 343-6325
Entity
Organization
Contact information
Practice address
1800 W CUMMINGS AVE, OPP, AL 36467
(334) 493-4357
(334) 493-3836
Mailing address
1800 W CUMMINGS AVE, OPP, AL 36467
(334) 493-4357
(334) 493-3836
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2926
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609245034
INDIVIDUAL NPI
AL
01
—
2926
AL LICENSE NUMBER FOR MASSAGE
AL
Enumeration date
10/16/2015
Last updated
10/16/2015
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