Provider Demographics
NPI:1053555482
Name:SWEDISH DREAMS MASSAGE THERAPY CLINIC
Entity type:Organization
Organization Name:SWEDISH DREAMS MASSAGE THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:770-774-3545
Mailing Address - Street 1:6015 LYNMARK WAY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4391
Mailing Address - Country:US
Mailing Address - Phone:770-774-3545
Mailing Address - Fax:770-774-3546
Practice Address - Street 1:6015 LYNMARK WAY
Practice Address - Street 2:SUITE 114
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4391
Practice Address - Country:US
Practice Address - Phone:770-774-3545
Practice Address - Fax:770-774-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002411173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty