Provider Demographics
NPI:1356690358
Name:A BODY IN KNEAD, LLC
Entity Type:Organization
Organization Name:A BODY IN KNEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT/MA
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:207-989-7473
Mailing Address - Street 1:263 STATE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5435
Mailing Address - Country:US
Mailing Address - Phone:207-989-7473
Mailing Address - Fax:
Practice Address - Street 1:263 STATE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5435
Practice Address - Country:US
Practice Address - Phone:207-989-7473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty