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General NPI Number Information
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NPI Number | 1083950406
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Entity Type | Organization
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Legal Business Name | BODY BALANCE THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 210 PROFESSIONAL PARK DR SE SUITE 10
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-605-8751
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Fax | 540-750-4062
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Provider Business Mailing Address
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Address Line | 210 PROFESSIONAL PARK DR SE SUITE 10
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-605-8751
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Fax | 540-750-4062
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Authorized Official
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Title or Position | OWNER, MASSAGE THERAPIST
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Name | MRS. CARRIE E BOUCHER
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Credential | LMT
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Telephone | 540-449-4235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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