1770605537 NPI number — INWARD GLANCE INC

Table of content: (NPI 1770605537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770605537 NPI number — INWARD GLANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INWARD GLANCE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CRANIOSACRAL THERAPY ASSOCIATES INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770605537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 KILBURN STREET
Provider Second Line Business Mailing Address:
THE BODY CENTER
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-865-9500
Provider Business Mailing Address Fax Number:
802-865-9559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 KILBURN STREET
Provider Second Line Business Practice Location Address:
THE BODY CENTER
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-865-9500
Provider Business Practice Location Address Fax Number:
802-865-9559
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-865-9500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0400003529 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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