Provider Demographics
NPI:1891475554
Name:HOLISTIC MASSAGE AND BODYWORKS
Entity Type:Organization
Organization Name:HOLISTIC MASSAGE AND BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-248-0251
Mailing Address - Street 1:4262 BLUE DIAMOND RD STE 102-389
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7789
Mailing Address - Country:US
Mailing Address - Phone:725-248-0251
Mailing Address - Fax:
Practice Address - Street 1:2291 S FORT APACHE RD STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5895
Practice Address - Country:US
Practice Address - Phone:702-776-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty