Provider Demographics
NPI:1982048898
Name:THE WELLNESS JOURNEY STUDIO
Entity Type:Organization
Organization Name:THE WELLNESS JOURNEY STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAKER-BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:866-577-8344
Mailing Address - Street 1:685 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3072
Mailing Address - Country:US
Mailing Address - Phone:866-577-8344
Mailing Address - Fax:
Practice Address - Street 1:685 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3072
Practice Address - Country:US
Practice Address - Phone:866-577-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1279261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000OtherTHERAPEUTIC MASSAGE THERAPY