Provider Demographics
NPI:1881098648
Name:BLOOMINGTON MASSAGE & BODYWORKS
Entity type:Organization
Organization Name:BLOOMINGTON MASSAGE & BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:812-333-4917
Mailing Address - Street 1:101 W KIRKWOOD AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6129
Mailing Address - Country:US
Mailing Address - Phone:812-333-4917
Mailing Address - Fax:
Practice Address - Street 1:101 W KIRKWOOD AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6129
Practice Address - Country:US
Practice Address - Phone:812-333-4917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty