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General NPI Number Information
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NPI Number | 1710278338
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC BODY SHOPPE, LLC
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 765 W NORTON AVE
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City | NORTON SHORES
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State | MI
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Zip | 49441-4750
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Country | US
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Telephone | 231-747-9163
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Fax | 888-224-6798
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Provider Business Mailing Address
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Address Line | 765 W NORTON AVE
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City | NORTON SHORES
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State | MI
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Zip | 49441-4750
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Country | US
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Telephone | 231-747-9163
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Fax | 888-224-6798
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | MS. JODY L GREGG
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Credential | LMT
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Telephone | 231-747-9163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 7501000434
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501000434
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License Number State | MI
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