=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457668857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BODY & SOUL THERAPY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2010
-----------------------------------------------------
Last Update Date | 09/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 357 N ROYAL POINCIANA BLVD #105
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-603-9859
-----------------------------------------------------
Fax | 305-603-9861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 357 N ROYAL POINCIANA BLVD #105
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-603-9859
-----------------------------------------------------
Fax | 305-603-9861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MINERVA GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-603-9859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------