Healthcare Provider Details

I. General information

NPI: 1194646935
Provider Name (Legal Business Name): HOLISTIC BODY SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 OGLETHORPE PROFESSIONAL CT STE 3
SAVANNAH GA
31406-3664
US

IV. Provider business mailing address

117 OGLETHORPE PROFESSIONAL CT STE 3
SAVANNAH GA
31406-3664
US

V. Phone/Fax

Practice location:
  • Phone: 912-483-9073
  • Fax:
Mailing address:
  • Phone:
  • 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: CAMERON CIETEK
Title or Position: OWNER
Credential: LMT
Phone: 912-483-9073