Provider Demographics
NPI:1417197211
Name:JOE'S BODY SHOP INC
Entity Type:Organization
Organization Name:JOE'S BODY SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT, RM
Authorized Official - Phone:719-444-0708
Mailing Address - Street 1:2760 N ACADEMY BLVD
Mailing Address - Street 2:SUITE #135
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5325
Mailing Address - Country:US
Mailing Address - Phone:719-444-0708
Mailing Address - Fax:
Practice Address - Street 1:2760 N ACADEMY BLVD
Practice Address - Street 2:SUITE #135
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5324
Practice Address - Country:US
Practice Address - Phone:719-444-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty