Provider Demographics
NPI:1558381160
Name:RELAX A BACK BODYWORKS LLC
Entity Type:Organization
Organization Name:RELAX A BACK BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-859-9953
Mailing Address - Street 1:PO BOX 44128
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0128
Mailing Address - Country:US
Mailing Address - Phone:208-859-9953
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:448 S MAPLEGROVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-859-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTIN NUMBER
ID=========OtherTIN NUMBER