Provider Demographics
NPI:1700423043
Name:STRUCTURA BODY THERAPIES, LLC
Entity Type:Organization
Organization Name:STRUCTURA BODY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-897-8711
Mailing Address - Street 1:6160 TUTT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3503
Mailing Address - Country:US
Mailing Address - Phone:801-897-8711
Mailing Address - Fax:
Practice Address - Street 1:6160 TUTT BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3503
Practice Address - Country:US
Practice Address - Phone:801-897-8711
Practice Address - Fax:385-333-7202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRUCTURA INSTITUTE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty