Provider Demographics
NPI:1528512282
Name:TEJASE BODYWORKS
Entity type:Organization
Organization Name:TEJASE BODYWORKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE AND YOGA THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSYT, LMT, RYT
Authorized Official - Phone:540-535-6188
Mailing Address - Street 1:330 FUNK LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-5909
Mailing Address - Country:US
Mailing Address - Phone:540-535-6188
Mailing Address - Fax:
Practice Address - Street 1:50 INDEPENDENCE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1652
Practice Address - Country:US
Practice Address - Phone:540-535-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty