Healthcare Provider Details

I. General information

NPI: 1417693326
Provider Name (Legal Business Name): THE BODY SHOP THERAPEUTIC MASSAGE N SPA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 1675 RD
DELTA CO
81416
US

IV. Provider business mailing address

697 1675 RD
DELTA CO
81416-3462
US

V. Phone/Fax

Practice location:
  • Phone: 970-985-1491
  • Fax:
Mailing address:
  • Phone: 970-985-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA PETERS
Title or Position: OWNER/MANAGER
Credential: MMT
Phone: 970-712-4305