Provider Demographics
NPI:1326337684
Name:BLANACED BODY THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:BLANACED BODY THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUDOUX
Authorized Official - Suffix:
Authorized Official - Credentials:HHP, CMT
Authorized Official - Phone:760-216-4270
Mailing Address - Street 1:1820 MELROSE DR
Mailing Address - Street 2:#331
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2116
Mailing Address - Country:US
Mailing Address - Phone:760-216-4270
Mailing Address - Fax:
Practice Address - Street 1:1991 VILLAGE PARK WAY
Practice Address - Street 2:SUITE 206-A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1994
Practice Address - Country:US
Practice Address - Phone:760-216-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty