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General NPI Number Information
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NPI Number | 1407124209
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Entity Type | Organization
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Legal Business Name | BODY MOVEMENT ENERGY
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 111 S 4TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2801
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Country | US
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Telephone | 304-566-4438
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Fax |
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Provider Business Mailing Address
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Address Line | 111 S 4TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | WV LICENSED MASSAGE THERAPIST
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Name | DONETTA BOOTH WATSON
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Credential | LMT
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Telephone | 304-203-3779
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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 | 20112912
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License Number State | WV
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