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General NPI Number Information
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NPI Number | 1134586910
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Entity Type | Organization
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Legal Business Name | BODY ESSENTIALS THERAPEUTIC MASSAGE, LLC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 7740 ALLEN RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-1795
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Country | US
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Telephone | 313-383-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 7740 ALLEN RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-1795
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Country | US
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Telephone | 313-383-4263
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | RAYLEEN JUSTICE
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Credential | RN, LMT
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Telephone | 313-383-4263
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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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