Provider Demographics
NPI:1891076741
Name:REJUVENATE BODYWORKS, PL
Entity Type:Organization
Organization Name:REJUVENATE BODYWORKS, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:863-397-7531
Mailing Address - Street 1:11919 BACKLAND PATH RD
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-2604
Mailing Address - Country:US
Mailing Address - Phone:863-397-7531
Mailing Address - Fax:
Practice Address - Street 1:112 E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4965
Practice Address - Country:US
Practice Address - Phone:863-397-7531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty