Provider Demographics
NPI:1740971217
Name:SPORT & INJURY BODYWORKS
Entity type:Organization
Organization Name:SPORT & INJURY BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CPT
Authorized Official - Phone:352-308-7253
Mailing Address - Street 1:487 BRAD MARY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-3602
Mailing Address - Country:US
Mailing Address - Phone:352-308-7253
Mailing Address - Fax:
Practice Address - Street 1:655 NW FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2459
Practice Address - Country:US
Practice Address - Phone:706-614-8062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty