Provider Demographics
NPI:1497973614
Name:B-WELL MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:B-WELL MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-587-3828
Mailing Address - Street 1:13 S CARLL AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3401
Mailing Address - Country:US
Mailing Address - Phone:631-587-3828
Mailing Address - Fax:631-587-3588
Practice Address - Street 1:13 S CARLL AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3401
Practice Address - Country:US
Practice Address - Phone:631-587-3828
Practice Address - Fax:631-587-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty