Provider Demographics
NPI:1427824481
Name:LOVE & LIGHT BODYWORK LLC
Entity type:Organization
Organization Name:LOVE & LIGHT BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FELICIONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:772-341-4811
Mailing Address - Street 1:1015 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2923
Mailing Address - Country:US
Mailing Address - Phone:772-341-4811
Mailing Address - Fax:
Practice Address - Street 1:1320 SE FEDERAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3409
Practice Address - Country:US
Practice Address - Phone:772-341-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty