Provider Demographics
NPI:1023842309
Name:BODYLOGIC MASSAGE THERAPY LLC
Entity type:Organization
Organization Name:BODYLOGIC MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SHARIS
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:248-508-6056
Mailing Address - Street 1:23077 GREENFIELD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3768
Mailing Address - Country:US
Mailing Address - Phone:248-508-6056
Mailing Address - Fax:248-557-4544
Practice Address - Street 1:23077 GREENFIELD RD STE 250
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3768
Practice Address - Country:US
Practice Address - Phone:248-508-6056
Practice Address - Fax:248-557-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty