Provider Demographics
NPI:1023888906
Name:LUSH BODYWORX LLC
Entity type:Organization
Organization Name:LUSH BODYWORX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:832-758-2563
Mailing Address - Street 1:19293 MARY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2633
Mailing Address - Country:US
Mailing Address - Phone:832-758-2563
Mailing Address - Fax:
Practice Address - Street 1:208 MCCOWAN ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4433
Practice Address - Country:US
Practice Address - Phone:832-758-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty