Provider Demographics
NPI:1134683014
Name:BODYSMART MASSAGE & BODYWORK LLC
Entity Type:Organization
Organization Name:BODYSMART MASSAGE & BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:LAFLAMME
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:517-392-0224
Mailing Address - Street 1:4130 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5420
Mailing Address - Country:US
Mailing Address - Phone:480-630-2313
Mailing Address - Fax:
Practice Address - Street 1:1940 E CAMELBACK RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4130
Practice Address - Country:US
Practice Address - Phone:480-630-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty