Provider Demographics
NPI:1245875772
Name:THE CENTER FOR TOTAL BODY AWARENESS CORPORATION
Entity type:Organization
Organization Name:THE CENTER FOR TOTAL BODY AWARENESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:425-954-7303
Mailing Address - Street 1:218 MAIN ST # 204
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6199
Mailing Address - Country:US
Mailing Address - Phone:425-954-7303
Mailing Address - Fax:208-247-9260
Practice Address - Street 1:611 4TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6019
Practice Address - Country:US
Practice Address - Phone:425-954-7303
Practice Address - Fax:208-247-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty