Provider Demographics
NPI:1316826530
Name:GROUNDED BODYWORK BY MELISSA LLC
Entity type:Organization
Organization Name:GROUNDED BODYWORK BY MELISSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:928-358-8604
Mailing Address - Street 1:17498 BETTINA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8721
Mailing Address - Country:US
Mailing Address - Phone:928-358-8604
Mailing Address - Fax:
Practice Address - Street 1:11450 ROJAS DR STE D20
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6995
Practice Address - Country:US
Practice Address - Phone:928-358-8604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty