Provider Demographics
NPI:1013295666
Name:MANTRA MASSAGE AND BODYWORX, LLC
Entity type:Organization
Organization Name:MANTRA MASSAGE AND BODYWORX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-518-2719
Mailing Address - Street 1:4675 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6182
Mailing Address - Country:US
Mailing Address - Phone:513-891-1324
Mailing Address - Fax:513-891-1324
Practice Address - Street 1:4675 COOPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6182
Practice Address - Country:US
Practice Address - Phone:513-891-1324
Practice Address - Fax:513-891-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3655111N00000X
OH65.000207171100000X
OH018443225700000X
OH018315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty