Provider Demographics
NPI:1861876591
Name:BODY RESOLUTION LLC
Entity type:Organization
Organization Name:BODY RESOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS, CPT, CES, PES
Authorized Official - Phone:802-598-8334
Mailing Address - Street 1:2069 WILLISTON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6018
Mailing Address - Country:US
Mailing Address - Phone:802-658-5800
Mailing Address - Fax:
Practice Address - Street 1:2069 WILLISTON RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6018
Practice Address - Country:US
Practice Address - Phone:802-658-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.01133492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT104.0113349OtherATHLETIC TRAINER