Provider Demographics
NPI:1073120317
Name:BODY TECH MASSAGE & WELLNESS
Entity Type:Organization
Organization Name:BODY TECH MASSAGE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORNINGSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-762-6772
Mailing Address - Street 1:2151 W HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7414
Mailing Address - Country:US
Mailing Address - Phone:208-762-6772
Mailing Address - Fax:
Practice Address - Street 1:2151 W HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7414
Practice Address - Country:US
Practice Address - Phone:208-762-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care