Provider Demographics
NPI:1659037851
Name:CONSCIENTIOUS BODYWORKS, LLC
Entity Type:Organization
Organization Name:CONSCIENTIOUS BODYWORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RICO
Authorized Official - Last Name:AGUDELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-454-4766
Mailing Address - Street 1:7011 E BLUE LUPINE DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8457
Mailing Address - Country:US
Mailing Address - Phone:407-454-4766
Mailing Address - Fax:
Practice Address - Street 1:7011 E BLUE LUPINE DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8457
Practice Address - Country:US
Practice Address - Phone:407-454-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty