Provider Demographics
NPI:1831478718
Name:BODYWORK AND MASSAGE CENTER
Entity Type:Organization
Organization Name:BODYWORK AND MASSAGE CENTER
Other - Org Name:ORGANIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-352-4511
Mailing Address - Street 1:1210 SLEATER KINNEY ROAD SOUTEAST
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-352-4511
Mailing Address - Fax:360-754-4703
Practice Address - Street 1:1210 SLEATER KINNEY ROAD SOUTEAST
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-352-4511
Practice Address - Fax:360-754-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty