Provider Demographics
NPI:1003509050
Name:BODY WELL RETREAT LLC
Entity Type:Organization
Organization Name:BODY WELL RETREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OVANDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:585-210-3439
Mailing Address - Street 1:97 PARK AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2431
Mailing Address - Country:US
Mailing Address - Phone:585-210-3439
Mailing Address - Fax:585-486-7789
Practice Address - Street 1:97 PARK AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2431
Practice Address - Country:US
Practice Address - Phone:585-210-3439
Practice Address - Fax:585-486-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty