Provider Demographics
NPI:1285033811
Name:QICK STRETCH & BODY WORKS LLC
Entity Type:Organization
Organization Name:QICK STRETCH & BODY WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-338-5050
Mailing Address - Street 1:5050 CHAMPION BLVD
Mailing Address - Street 2:BLDG 5 SUITE 118
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4438
Mailing Address - Country:US
Mailing Address - Phone:561-929-8202
Mailing Address - Fax:
Practice Address - Street 1:3480 BANKS RD
Practice Address - Street 2:APT 205
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-8428
Practice Address - Country:US
Practice Address - Phone:305-709-8663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty