Provider Demographics
NPI:1487320461
Name:YOGA THERAPY BAR LLC
Entity type:Organization
Organization Name:YOGA THERAPY BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEKITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:864-906-5045
Mailing Address - Street 1:111 EARLE ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1545
Mailing Address - Country:US
Mailing Address - Phone:864-722-9035
Mailing Address - Fax:
Practice Address - Street 1:111 EARLE ST STE D
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1545
Practice Address - Country:US
Practice Address - Phone:864-722-9035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty