Provider Demographics
NPI:1083950406
Name:BODY BALANCE THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:BODY BALANCE THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:540-449-4235
Mailing Address - Street 1:210 PROFESSIONAL PARK DR SE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-605-8751
Mailing Address - Fax:540-750-4062
Practice Address - Street 1:210 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 10
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-605-8751
Practice Address - Fax:540-750-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty