Provider Demographics
NPI:1285043034
Name:YOUR BODY SHOPPE
Entity Type:Organization
Organization Name:YOUR BODY SHOPPE
Other - Org Name:ESSENCE OF TOUCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:STICKROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-412-7614
Mailing Address - Street 1:12001 TEJON ST
Mailing Address - Street 2:122
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12001 TEJON ST
Practice Address - Street 2:122
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2310
Practice Address - Country:US
Practice Address - Phone:970-412-7614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty