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General NPI Number Information
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NPI Number | 1790502144
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Entity Type | Organization
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Legal Business Name | BODHI LLC
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | BODHI LLC CARRETERA #2 KM 16.8 CANDELARIA
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-244-9451
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Fax |
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Provider Business Mailing Address
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Address Line | URB. EL PLANTIO CALLE JACANA G19F
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-244-9451
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | CARLA MICHELLE MARTIS VARGAS
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Credential | LMT
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Telephone | 787-244-9451
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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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