Provider Demographics
NPI:1295226926
Name:ARCHER BODYWORKS LLC
Entity Type:Organization
Organization Name:ARCHER BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:I
Authorized Official - Last Name:HALL
Authorized Official - Suffix:III
Authorized Official - Credentials:MT/BHT
Authorized Official - Phone:520-304-5330
Mailing Address - Street 1:933 N MAIN AVE UNIT 131
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7617
Mailing Address - Country:US
Mailing Address - Phone:520-304-5330
Mailing Address - Fax:
Practice Address - Street 1:4625 E BROADWAY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3575
Practice Address - Country:US
Practice Address - Phone:520-304-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty