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General NPI Number Information
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NPI Number | 1356715429
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Entity Type | Organization
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Legal Business Name | BODY KNEADS LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 19 MAIN AVE
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City | LOGAN
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State | WV
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Zip | 25601-3332
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Country | US
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Telephone | 304-752-2220
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Fax | 304-752-3010
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Provider Business Mailing Address
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Address Line | 19 MAIN AVE
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City | LOGAN
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State | WV
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Zip | 25601-3332
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Country | US
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Telephone | 304-752-2220
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Fax | 304-752-3010
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOY QUEEN
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Credential |
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Telephone | 304-752-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2014-3228
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License Number State | WV
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