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General NPI Number Information
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NPI Number | 1932416641
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Entity Type | Organization
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Legal Business Name | ARIZONA BODYWORKS & FITNESS LLC
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1000 AINSWORTH DR STE A230
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City | PRESCOTT
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State | AZ
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Zip | 86305-1683
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Country | US
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Telephone | 928-771-8190
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Fax | 928-237-4430
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Provider Business Mailing Address
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Address Line | 432 S MARINA ST
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City | PRESCOTT
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State | AZ
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Zip | 86303-4324
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Country | US
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Telephone | 928-771-8190
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Fax | 928-237-4430
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. TROY J MARTIN
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Credential | LMT
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Telephone | 928-771-8190
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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 | MT-11913
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License Number State | AZ
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