Provider Demographics
NPI:1902929334
Name:BODY LOGIC ALTERNATIVE THERAPIES, INC.
Entity Type:Organization
Organization Name:BODY LOGIC ALTERNATIVE THERAPIES, INC.
Other - Org Name:BODY LOGIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:NEVILLE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:269-983-7858
Mailing Address - Street 1:1515 NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1585
Mailing Address - Country:US
Mailing Address - Phone:269-983-7858
Mailing Address - Fax:269-983-8986
Practice Address - Street 1:1515 NILES AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1585
Practice Address - Country:US
Practice Address - Phone:269-983-7858
Practice Address - Fax:269-983-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty