Provider Demographics
NPI:1952058539
Name:ENTIRE RECOVERY BODYWORKS, LLC
Entity Type:Organization
Organization Name:ENTIRE RECOVERY BODYWORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GIANINA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MMP, LMT, CMT
Authorized Official - Phone:571-245-4638
Mailing Address - Street 1:604 SUGARLAND RUN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1115
Mailing Address - Country:US
Mailing Address - Phone:571-245-4638
Mailing Address - Fax:
Practice Address - Street 1:604 SUGARLAND RUN DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-1115
Practice Address - Country:US
Practice Address - Phone:571-245-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty