Healthcare Provider Details

I. General information

NPI: 1609884279
Provider Name (Legal Business Name): BODY WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2787 E OAKLAND PARK BLVD STE 204
FORT LAUDERDALE FL
33306-1647
US

IV. Provider business mailing address

2787 E OAKLAND PARK BLVD STE 204
FORT LAUDERDALE FL
33306-1647
US

V. Phone/Fax

Practice location:
  • Phone: 954-496-2503
  • Fax:
Mailing address:
  • Phone: 954-784-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberMA 44521
License Number StateFL

VIII. Authorized Official

Name: DANIEL MELMED
Title or Position: OWNER
Credential: LMT
Phone: 954-496-2503