Healthcare Provider Details

I. General information

NPI: 1770446841
Provider Name (Legal Business Name): BODY VITALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 E WILLIAMS FIELD RD STE 200
GILBERT AZ
85295-0160
US

IV. Provider business mailing address

2174 E WILLIAMS FIELD RD STE 200
GILBERT AZ
85295-0160
US

V. Phone/Fax

Practice location:
  • Phone: 602-824-8466
  • Fax: 833-973-5655
Mailing address:
  • Phone: 602-824-8466
  • Fax: 833-973-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAUL SCHMIDT
Title or Position: OWNER/PROVIDER
Credential: PA
Phone: 602-824-8466