Provider Demographics
NPI:1700208386
Name:CUSTOMIZED MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:CUSTOMIZED MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:817-645-3061
Mailing Address - Street 1:426 W CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5425
Mailing Address - Country:US
Mailing Address - Phone:817-645-3061
Mailing Address - Fax:
Practice Address - Street 1:426 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5425
Practice Address - Country:US
Practice Address - Phone:817-645-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113016261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center