MEDICARE: BODY RESONANCE MYOFASCIAL WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1447087333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY RESONANCE MYOFASCIAL WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	8724 SPANISH RIDGE AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1496
Country	:	US
Telephone Number	:	702-776-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	8724 SPANISH RIDGE AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1496
Country	:	US
Telephone Number	:	702-776-8881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROWENA CUA
Credential	:	LMT
Telephone Number	:	702-776-8881

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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