Basic Information
| Provider Information | |||||||||
| NPI: | 1558381160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RELAX A BACK BODYWORKS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44128 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837110128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088599953 | ||||||||
| FaxNumber: | 2083239070 | ||||||||
| Practice Location | |||||||||
| Address1: | 448 S MAPLEGROVE | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088599953 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | GAREY | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2088599953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.