Provider Demographics
NPI:1639467475
Name:BODY MECHANIX, LLC THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:BODY MECHANIX, LLC THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:901-323-1220
Mailing Address - Street 1:3486 POPLAR AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4693
Mailing Address - Country:US
Mailing Address - Phone:901-323-1220
Mailing Address - Fax:
Practice Address - Street 1:3486 POPLAR AVE
Practice Address - Street 2:STE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4693
Practice Address - Country:US
Practice Address - Phone:901-323-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMT1879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty