Organization
MY MASSAGE SANCTUARY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEILA I KAYSER CEO (CEO)
(815) 301-7809
Entity
Organization
Contact information
Practice address
101 NORTH ALPINE ROAD, ROCKFORD, IL 61107
(779) 423-1700
(866) 596-1027
Mailing address
101 NORTH ALPINE ROAD, ROCKFORD, IL 61107
(779) 423-1700
(866) 596-1027
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
227.003938
IL
261QM1300X
Multi-Specialty Clinic/Center
198.000709
IL
Other
Enumeration date
03/19/2009
Last updated
03/19/2009
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