Provider Demographics
NPI:1669897328
Name:BODY & SOLE, LLC.
Entity type:Organization
Organization Name:BODY & SOLE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:970-682-2038
Mailing Address - Street 1:2601 S LEMAY AVE
Mailing Address - Street 2:SUITE 35
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2295
Mailing Address - Country:US
Mailing Address - Phone:970-682-2038
Mailing Address - Fax:970-682-2592
Practice Address - Street 1:2601 S LEMAY AVE
Practice Address - Street 2:SUITE 35
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2295
Practice Address - Country:US
Practice Address - Phone:970-682-2038
Practice Address - Fax:970-682-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty