Provider Demographics
NPI:1144423047
Name:THERAPEUTIC ARTS OF MASSAGE & BODYWORK LLC
Entity Type:Organization
Organization Name:THERAPEUTIC ARTS OF MASSAGE & BODYWORK LLC
Other - Org Name:THERAPEUTIC ARTS OF MASSAGE & BODYWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:II
Authorized Official - Credentials:LMT
Authorized Official - Phone:623-628-3279
Mailing Address - Street 1:13026 W RANCHO SANTA FE BLVD
Mailing Address - Street 2:B100
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-935-7900
Mailing Address - Fax:623-935-7905
Practice Address - Street 1:13026 W RANCHO SANTA FE BLVD
Practice Address - Street 2:B100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-935-7900
Practice Address - Fax:623-935-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT07261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty