Provider Demographics
NPI:1134586910
Name:BODY ESSENTIALS THERAPEUTIC MASSAGE, LLC
Entity type:Organization
Organization Name:BODY ESSENTIALS THERAPEUTIC MASSAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:313-383-4263
Mailing Address - Street 1:7740 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1795
Mailing Address - Country:US
Mailing Address - Phone:313-383-4263
Mailing Address - Fax:
Practice Address - Street 1:7740 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1795
Practice Address - Country:US
Practice Address - Phone:313-383-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNKNOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty