Provider Demographics
NPI:1710355599
Name:QUIET RIVER MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:QUIET RIVER MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANUAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT NCMT
Authorized Official - Phone:928-273-6897
Mailing Address - Street 1:132 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3206
Mailing Address - Country:US
Mailing Address - Phone:928-273-6897
Mailing Address - Fax:
Practice Address - Street 1:132 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3206
Practice Address - Country:US
Practice Address - Phone:928-273-6897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-11435261QP2000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No302R00000XManaged Care OrganizationsHealth Maintenance Organization