MEDICARE: BODY DOJO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1982419461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY DOJO LLC

Provider Business Mailing Address
First Line	:	1059 GIULIA DR
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-4187
Country	:	US
Telephone Number	:	412-722-3618
Fax Number	:

Provider Business Practice Location Address
First Line	:	8958 HILL DR
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-3112
Country	:	US
Telephone Number	:	724-755-3020
Fax Number	:

Authorized Official
Title or Position	:	FOUNDING PARTNER
Name	:	COREY DEASY
Credential	:
Telephone Number	:	412-722-3618

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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Directions to “BODY DOJO LLC ” Practice Location

Language	Start Address	Practice Location

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