Provider Demographics
NPI:1154120905
Name:LARA HENDERSON BODYWORK LLC
Entity type:Organization
Organization Name:LARA HENDERSON BODYWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-587-8998
Mailing Address - Street 1:600 S AIRPORT RD BLDG A
Mailing Address - Street 2:STE G&H
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6424
Mailing Address - Country:US
Mailing Address - Phone:303-587-8998
Mailing Address - Fax:720-600-0402
Practice Address - Street 1:600 S AIRPORT RD BLDG A
Practice Address - Street 2:STE G&H
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6424
Practice Address - Country:US
Practice Address - Phone:303-587-8998
Practice Address - Fax:720-600-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies