Provider Demographics
NPI:1497268908
Name:BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP
Entity Type:Organization
Organization Name:BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-238-7909
Mailing Address - Street 1:HC 7 BOX 39597
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9220
Mailing Address - Country:US
Mailing Address - Phone:787-238-7909
Mailing Address - Fax:
Practice Address - Street 1:CARR 110 KM 4.9 INT BO AGUACATE
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-238-7909
Practice Address - Fax:787-238-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1422251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1356664726OtherPHYSICAL THERAPIST