Provider Demographics
NPI:1043945959
Name:THE BODY BAR WILLIAMSBURG
Entity type:Organization
Organization Name:THE BODY BAR WILLIAMSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-253-0619
Mailing Address - Street 1:1004 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1066
Mailing Address - Country:US
Mailing Address - Phone:606-215-3730
Mailing Address - Fax:
Practice Address - Street 1:1004 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1066
Practice Address - Country:US
Practice Address - Phone:606-215-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty