Provider Demographics
NPI:1457522518
Name:BODY HARMONY MASSAGE
Entity Type:Organization
Organization Name:BODY HARMONY MASSAGE
Other - Org Name:BODY HARMONY MASAAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WUNDERLICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-475-1238
Mailing Address - Street 1:1002 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-1708
Mailing Address - Country:US
Mailing Address - Phone:509-475-1238
Mailing Address - Fax:
Practice Address - Street 1:1002 1ST ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1708
Practice Address - Country:US
Practice Address - Phone:509-475-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025203261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1811167406OtherLIFE WISE
WA8111167406OtherCIGNA
WA1811167406OtherUNIFORM MEDICAL PLAN
WA1811167406OtherAETNA
WA1811167406OtherALTERNARE
WA1811167406Medicaid
WA1811167406OtherAMERICAN WHOLE HEALTH
WA1811167406OtherAETNA
WA8111167406OtherCIGNA
WA1811167406Medicare NSC
WA1811167406OtherUNIFORM MEDICAL PLAN