Provider Demographics
NPI:1902555188
Name:THE BODY SPA LLC
Entity Type:Organization
Organization Name:THE BODY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-391-1678
Mailing Address - Street 1:6820 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSET
Mailing Address - State:SD
Mailing Address - Zip Code:57718-9742
Mailing Address - Country:US
Mailing Address - Phone:605-391-1678
Mailing Address - Fax:
Practice Address - Street 1:3535 STURGIS RD STE 16
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2345
Practice Address - Country:US
Practice Address - Phone:605-391-1678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty