Provider Demographics
NPI:1689263949
Name:A MAGICAL ESCAPE THERAPEUTIC BODYWORKS LLC
Entity Type:Organization
Organization Name:A MAGICAL ESCAPE THERAPEUTIC BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:302-375-6533
Mailing Address - Street 1:2502 SILVERSIDE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3740
Mailing Address - Country:US
Mailing Address - Phone:302-375-6533
Mailing Address - Fax:
Practice Address - Street 1:2502 SILVERSIDE RD STE 9
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3740
Practice Address - Country:US
Practice Address - Phone:302-375-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty