Provider Demographics
NPI:1407124209
Name:BODY MOVEMENT ENERGY
Entity Type:Organization
Organization Name:BODY MOVEMENT ENERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WV LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONETTA
Authorized Official - Middle Name:BOOTH
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:304-203-3779
Mailing Address - Street 1:111 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2801
Practice Address - Country:US
Practice Address - Phone:304-566-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20112912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty