Provider Demographics
NPI:1730227232
Name:HOLISTIC BODYWORK LLC
Entity type:Organization
Organization Name:HOLISTIC BODYWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MHR MRG
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L RAYMOND
Authorized Official - Last Name:FLASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-794-5389
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:360-794-5389
Mailing Address - Fax:360-794-5389
Practice Address - Street 1:17801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-794-5389
Practice Address - Fax:360-794-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty