Provider Demographics
NPI:1932344504
Name:BODYWORKS ETC LTD
Entity Type:Organization
Organization Name:BODYWORKS ETC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PORCINO
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:570-620-7540
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-0029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 314
Practice Address - Street 2:
Practice Address - City:POCONO MANOR
Practice Address - State:PA
Practice Address - Zip Code:18349
Practice Address - Country:US
Practice Address - Phone:570-839-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty