Provider Demographics
NPI:1215000419
Name:LAUREN WOOD MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:LAUREN WOOD MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:LEILANI
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:941-358-5290
Mailing Address - Street 1:1666 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-358-5290
Mailing Address - Fax:941-366-1326
Practice Address - Street 1:665 S ORANGE AVE REAR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-358-5290
Practice Address - Fax:941-366-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA19737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC6681OtherBCBS OF FL