Provider Demographics
NPI:1285983130
Name:BIODYNAMIC YOU, LLC
Entity type:Organization
Organization Name:BIODYNAMIC YOU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALING ARTS PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LCMT
Authorized Official - Phone:307-630-3621
Mailing Address - Street 1:408 WEST PERSHING BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-630-3621
Mailing Address - Fax:
Practice Address - Street 1:408 WEST PERSHING BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-630-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOL-13-00087OtherCITY OF CHEYENNE, WYOMING LICENSE/PERMIT