Basic Information
| Provider Information | |||||||||
| NPI: | 1700153251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIMA KAI MASSAGE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 3RD ST NW | ||||||||
| Address2: | SUITE #67 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052471469 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 3RD ST NW | ||||||||
| Address2: | SUITE #67 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052471469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2011 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | DEYHLE | ||||||||
| AuthorizedOfficialFirstName: | KARA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5052471469 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 6323 | NM | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.