Provider Demographics
NPI:1760787048
Name:BIO-HEALTH THERAPY MASSAGE & BODYWORK REHAB
Entity Type:Organization
Organization Name:BIO-HEALTH THERAPY MASSAGE & BODYWORK REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE & BODYWORK REHAB THERAPIST/
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:NCMBT
Authorized Official - Phone:810-813-3776
Mailing Address - Street 1:29344 HOOVER ROAD
Mailing Address - Street 2:#206
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:810-813-3776
Mailing Address - Fax:248-723-4880
Practice Address - Street 1:29344 HOOVER ROAD
Practice Address - Street 2:#206
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:810-813-3776
Practice Address - Fax:248-723-4880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIO-HEALTH THERAPY MASSAGE & BODYWORK REHAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
576415-09172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty