Provider Demographics
NPI:1063650810
Name:THE CENTER FOR THERAPEUTIC BODYWORK, LLC.
Entity type:Organization
Organization Name:THE CENTER FOR THERAPEUTIC BODYWORK, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:973-891-1733
Mailing Address - Street 1:96 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3524
Mailing Address - Country:US
Mailing Address - Phone:973-891-1733
Mailing Address - Fax:973-891-1734
Practice Address - Street 1:96 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3524
Practice Address - Country:US
Practice Address - Phone:973-891-1733
Practice Address - Fax:973-891-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00102200173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ173C00000XOtherREFLEXOLOGIST
NJ225700000XOtherMASSAGE THERAPIST
NJ364SH1100XOtherHOLISTIC
NJ174400000XOtherSPECIALIST