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General NPI Number Information
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NPI Number | 1528372364
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Entity Type | Organization
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Legal Business Name | THE BODY CENTER
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 502 E CHICKASAW AVE SUITE D
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City | MCALESTER
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State | OK
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Zip | 74501-5305
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Country | US
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Telephone | 918-916-3049
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3672
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City | MCALESTER
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State | OK
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Zip | 74502-3672
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Country | US
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Telephone | 918-916-3049
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | JENNIFER ROBIN
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Credential | NCTMB
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Telephone | 918-916-3049
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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 |
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License Number State |
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