Provider Demographics
NPI:1538507645
Name:BOBW BODYWORK, LLC
Entity Type:Organization
Organization Name:BOBW BODYWORK, LLC
Other - Org Name:BEST OF BOTH WORLDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CAMT
Authorized Official - Phone:609-519-3233
Mailing Address - Street 1:444 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2372
Mailing Address - Country:US
Mailing Address - Phone:609-519-3233
Mailing Address - Fax:
Practice Address - Street 1:444 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2372
Practice Address - Country:US
Practice Address - Phone:609-519-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00226400171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty