Provider Demographics
NPI:1861814329
Name:ADVANCED BODYWORK THERAPY INC
Entity Type:Organization
Organization Name:ADVANCED BODYWORK THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KYLAN
Authorized Official - Middle Name:ROBYN
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMP,NCTMB
Authorized Official - Phone:360-271-2268
Mailing Address - Street 1:16661 NW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9002
Mailing Address - Country:US
Mailing Address - Phone:360-271-2268
Mailing Address - Fax:360-779-5373
Practice Address - Street 1:19068 NW JENSEN WAY
Practice Address - Street 2:SUITE 4B
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-271-2268
Practice Address - Fax:360-779-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty