Provider Demographics
NPI:1265960439
Name:INDY MASSAGE COMPANY
Entity type:Organization
Organization Name:INDY MASSAGE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:317-910-9354
Mailing Address - Street 1:4735 STATESMEN DR STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5647
Mailing Address - Country:US
Mailing Address - Phone:317-721-3189
Mailing Address - Fax:
Practice Address - Street 1:4735 STATESMEN DR STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5647
Practice Address - Country:US
Practice Address - Phone:317-721-3189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local