=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760787048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIO-HEALTH THERAPY MASSAGE & BODYWORK REHAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2011
-----------------------------------------------------
Last Update Date | 01/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29344 HOOVER ROAD #206
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-813-3776
-----------------------------------------------------
Fax | 248-723-4880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29344 HOOVER ROAD #206
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-813-3776
-----------------------------------------------------
Fax | 248-723-4880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE & BODYWORK REHAB THERAPIST/
-----------------------------------------------------
Name | PAMELA R SKINNER
-----------------------------------------------------
Credential | NCMBT
-----------------------------------------------------
Telephone | 810-813-3776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172M00000X
-----------------------------------------------------
Taxonomy Name | Mechanotherapist
-----------------------------------------------------
License Number | 576415-09
-----------------------------------------------------
License Number State |
-----------------------------------------------------