Provider Demographics
NPI:1972228997
Name:MYOGRASP BODYWORK
Entity Type:Organization
Organization Name:MYOGRASP BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:MICHAELA
Authorized Official - Last Name:SHATRAW
Authorized Official - Suffix:
Authorized Official - Credentials:MMP
Authorized Official - Phone:208-627-7637
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0769
Mailing Address - Country:US
Mailing Address - Phone:208-627-7637
Mailing Address - Fax:
Practice Address - Street 1:900 W ROBERT BUSH DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:208-627-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty