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General NPI Number Information
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NPI Number | 1740971217
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Entity Type | Organization
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Legal Business Name | SPORT & INJURY BODYWORKS
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 655 NW FRONTAGE RD
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City | AUGUSTA
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State | GA
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Zip | 30907-2459
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Country | US
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Telephone | 706-614-8062
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Fax |
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Provider Business Mailing Address
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Address Line | 487 BRAD MARY LAKE RD
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City | HARLEM
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State | GA
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Zip | 30814-3602
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Country | US
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Telephone | 352-308-7253
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | STEPHANIE ANN HALL
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Credential | LMT, CPT
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Telephone | 352-308-7253
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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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