Provider Demographics
NPI:1568944999
Name:BODY BRAIN SYNC, INC
Entity Type:Organization
Organization Name:BODY BRAIN SYNC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER PAIN SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:856-514-1990
Mailing Address - Street 1:17 PERTH ST
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701
Mailing Address - Country:US
Mailing Address - Phone:302-498-9234
Mailing Address - Fax:855-210-6070
Practice Address - Street 1:412 CAPITOL TRAIL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-498-9234
Practice Address - Fax:855-210-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty