Provider Demographics
NPI:1962771584
Name:BODYWORKS THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:BODYWORKS THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:303-759-1400
Mailing Address - Street 1:4340 E KENTUCKY AVE STE 446
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2078
Mailing Address - Country:US
Mailing Address - Phone:303-759-1400
Mailing Address - Fax:888-308-3557
Practice Address - Street 1:4340 E KENTUCKY AVE STE 446
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2078
Practice Address - Country:US
Practice Address - Phone:303-759-1400
Practice Address - Fax:888-308-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty