Healthcare Provider Details

I. General information

NPI: 1124835822
Provider Name (Legal Business Name): WHOLE HEALTH BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 LAND GRANT ST UNIT 2
ST AUGUSTINE FL
32092-1693
US

IV. Provider business mailing address

225 LAND GRANT ST UNIT 2
ST AUGUSTINE FL
32092-1693
US

V. Phone/Fax

Practice location:
  • Phone: 610-425-7482
  • Fax:
Mailing address:
  • Phone: 904-297-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: PEYTON SCHULTZ
Title or Position: OWNER
Credential: LMT
Phone: 610-425-7482