Provider Demographics
NPI:1386816536
Name:UNLOCKING THE BODY, INC.
Entity Type:Organization
Organization Name:UNLOCKING THE BODY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-970-8256
Mailing Address - Street 1:PO BOX 45160
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98448-5150
Mailing Address - Country:US
Mailing Address - Phone:253-970-8256
Mailing Address - Fax:
Practice Address - Street 1:105 WEST MAIN
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-970-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00013998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty