Provider Demographics
NPI:1598162745
Name:ORTHOPEDIC MASSAGE & BODYWORK LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC MASSAGE & BODYWORK LLC
Other - Org Name:SEACOAST ORTHOPEDIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLISS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:603-812-7535
Mailing Address - Street 1:14 MANCHESTER SQ STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8003
Mailing Address - Country:US
Mailing Address - Phone:603-812-7535
Mailing Address - Fax:
Practice Address - Street 1:14 MANCHESTER SQ STE 120
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8003
Practice Address - Country:US
Practice Address - Phone:603-812-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2991M261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service