Provider Demographics
NPI:1528338837
Name:BODYOLOGY MASSAGE CENTER
Entity type:Organization
Organization Name:BODYOLOGY MASSAGE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:715-234-2400
Mailing Address - Street 1:1815B S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-3005
Mailing Address - Country:US
Mailing Address - Phone:715-234-2400
Mailing Address - Fax:715-234-2400
Practice Address - Street 1:1815B S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-3005
Practice Address - Country:US
Practice Address - Phone:715-234-2400
Practice Address - Fax:715-234-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4861-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty