Provider Demographics
NPI:1538352125
Name:ABSOLUTE BODY CARE, LLC
Entity type:Organization
Organization Name:ABSOLUTE BODY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:TYRONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:850-516-4574
Mailing Address - Street 1:4222 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4667
Mailing Address - Country:US
Mailing Address - Phone:850-516-4574
Mailing Address - Fax:
Practice Address - Street 1:4222 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4667
Practice Address - Country:US
Practice Address - Phone:850-516-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty