Provider Demographics
NPI:1427406628
Name:HIS & HER BODY TREATS
Entity Type:Organization
Organization Name:HIS & HER BODY TREATS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAGRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:321-373-2100
Mailing Address - Street 1:3870 DAIRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7605
Mailing Address - Country:US
Mailing Address - Phone:321-373-2100
Mailing Address - Fax:
Practice Address - Street 1:3870 DAIRY RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7605
Practice Address - Country:US
Practice Address - Phone:321-373-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69976172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty