Provider Demographics
NPI:1174231260
Name:REVIVING TOUCH CORRECTIVE MASSAGE, LLC
Entity type:Organization
Organization Name:REVIVING TOUCH CORRECTIVE MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:B
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-222-2042
Mailing Address - Street 1:3624 RED MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-5041
Mailing Address - Country:US
Mailing Address - Phone:870-810-8902
Mailing Address - Fax:870-345-7009
Practice Address - Street 1:2211 RACE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7218
Practice Address - Country:US
Practice Address - Phone:870-810-8902
Practice Address - Fax:870-345-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty