=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457795106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE BODY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2013
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 CHURCH STREET SUITE C
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-688-6390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 CHURCH STREET SUITE C
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-688-6390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LMT
-----------------------------------------------------
Name | MS. SHEILA T JOHNSON
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 985-688-6390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | #OC-22613
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | LMT#7266
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------