=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487932265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AERIALBODIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2011
-----------------------------------------------------
Last Update Date | 07/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2708 LAKE OSBORNE DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-5665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-856-0131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2708 LAKE OSBORNE DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-5665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-856-0131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | MRS. LYDIE ROBSHAM
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 561-856-0131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------