Provider Demographics
NPI:1548511975
Name:BE WELL THERAPEUTIC MASSAGE, LLC
Entity type:Organization
Organization Name:BE WELL THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:HODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-807-7609
Mailing Address - Street 1:5600 W BROWN DEER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2346
Mailing Address - Country:US
Mailing Address - Phone:414-807-7609
Mailing Address - Fax:414-221-0288
Practice Address - Street 1:2834 N 62ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2117
Practice Address - Country:US
Practice Address - Phone:414-807-7609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2513-146261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy