Provider Demographics
NPI:1215535844
Name:ANOMALY BODYWORK & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ANOMALY BODYWORK & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:703-863-9468
Mailing Address - Street 1:6032 QUEENS WALK CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7176
Mailing Address - Country:US
Mailing Address - Phone:703-863-9468
Mailing Address - Fax:
Practice Address - Street 1:4068 FLATS MAIN STREET
Practice Address - Street 2:APT 100
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707
Practice Address - Country:US
Practice Address - Phone:703-863-9468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty