Provider Demographics
NPI:1073913885
Name:PRO BODYWORKS THE SPA, LLC
Entity Type:Organization
Organization Name:PRO BODYWORKS THE SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-684-1420
Mailing Address - Street 1:162 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2406
Mailing Address - Country:US
Mailing Address - Phone:509-684-1420
Mailing Address - Fax:509-684-6293
Practice Address - Street 1:162 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2406
Practice Address - Country:US
Practice Address - Phone:509-684-1420
Practice Address - Fax:509-684-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60205525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty