Provider Demographics
NPI:1700328945
Name:BODY BALANCE BLISS
Entity Type:Organization
Organization Name:BODY BALANCE BLISS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MASSAGE THERAPIST, YOGA INST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:512-415-8537
Mailing Address - Street 1:PO BOX 6944
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-6944
Mailing Address - Country:US
Mailing Address - Phone:512-415-8537
Mailing Address - Fax:
Practice Address - Street 1:200 CAPITOL ST.
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:512-415-8537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty