1497268908 NPI number — BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP

Table of content: (NPI 1497268908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497268908 NPI number — BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP
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:
Provider Other Organization Name Type Code:
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:
1497268908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 7 BOX 39597
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-9220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-238-7909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 110 KM 4.9 INT BO AGUACATE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-238-7909
Provider Business Practice Location Address Fax Number:
787-238-7909
Provider Enumeration Date:
11/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FELICIANO
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
787-238-7909

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X , with the licence number:  142 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1356664726 . This is a "PHYSICAL THERAPIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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