Healthcare Provider Details

I. General information

NPI: 1497275812
Provider Name (Legal Business Name): HEALTHY BODIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6890 N FLORIDA AVE
HERNANDO FL
34442-3500
US

IV. Provider business mailing address

6890 N FLORIDA AVE
HERNANDO FL
34442-3500
US

V. Phone/Fax

Practice location:
  • Phone: 352-897-5293
  • Fax: 352-897-5307
Mailing address:
  • Phone: 352-897-5293
  • Fax: 352-897-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VALERI D HOUCK
Title or Position: OWNER
Credential: PA
Phone: 352-897-5293