Mesa Body Therapy, LLC
Clinic/Center in Rocheport, MO. Organization (NPI-2).
NPI number1013530252
StatusActive
Last updated in NPPESMay 22, 2020
Details
- NPI
- 1013530252
- Entity type
- Organization (NPI-2)
- Legal business name
- Mesa Body Therapy, LLC
- Organization subpart
- No
- Enumeration date
- May 22, 2020
- Certification date
- May 22, 2020
- Last updated
- May 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Other names
- Mesa Body Therapy (Doing Business As)
Practice location
97 Pike StRocheport, MO 65279-9392
Phone 573-489-6383
Mailing address
Po Box 45Rocheport, MO 65279-0045
Authorized official
Tawnee Benner
Member
5734896383
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