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General NPI Number Information
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NPI Number | 1902929334
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Entity Type | Organization
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Legal Business Name | BODY LOGIC ALTERNATIVE THERAPIES, INC.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 1515 NILES AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1585
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Country | US
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Telephone | 269-983-7858
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Fax | 269-983-8986
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Provider Business Mailing Address
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Address Line | 1515 NILES AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1585
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Country | US
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Telephone | 269-983-7858
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Fax | 269-983-8986
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | MRS. MARIA TERESA NEVILLE-SMITH
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Credential | CMT
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Telephone | 269-983-7858
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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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