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General NPI Number Information
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NPI Number | 1063295897
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Entity Type | Organization
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Legal Business Name | BADOLIAN ENTERPRISES, INC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1622 PORTER WAGONER BLVD STE 1
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City | WEST PLAINS
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State | MO
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Zip | 65775-1806
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Country | US
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Telephone | 417-274-6234
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Fax |
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Provider Business Mailing Address
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Address Line | 6304 COUNTY ROAD 1820
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City | POMONA
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State | MO
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Zip | 65789-9171
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Country | US
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Telephone | 417-274-6234
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Fax |
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Authorized Official
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Title or Position | CEO/MASSAGE THERAPIST
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Name | MRS. CYNTHIA THERESE BADOLIAN
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Credential | MASSAGE THERAPIST
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Telephone | 417-274-6234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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