Provider Demographics
NPI:1124401443
Name:STRUCTURA BODY THERAPIES, LLC
Entity Type:Organization
Organization Name:STRUCTURA BODY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, SIP
Authorized Official - Phone:801-888-0103
Mailing Address - Street 1:6112 S 1550 E
Mailing Address - Street 2:203
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5007
Mailing Address - Country:US
Mailing Address - Phone:801-897-8711
Mailing Address - Fax:801-475-1795
Practice Address - Street 1:6112 S 1550 E
Practice Address - Street 2:203
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5007
Practice Address - Country:US
Practice Address - Phone:801-897-8711
Practice Address - Fax:801-475-1795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRUCTURA HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-06
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7760739-4701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty