Provider Demographics
NPI:1316759723
Name:BACK TO BALANCE BODYWORK, LLC
Entity type:Organization
Organization Name:BACK TO BALANCE BODYWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMT
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIGON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-433-9480
Mailing Address - Street 1:14313 NE 20TH AVE STE A114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1485
Mailing Address - Country:US
Mailing Address - Phone:360-433-9480
Mailing Address - Fax:360-314-4268
Practice Address - Street 1:14313 NE 20TH AVE STE A114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1485
Practice Address - Country:US
Practice Address - Phone:360-433-9480
Practice Address - Fax:360-314-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty