Healthcare Provider Details

I. General information

NPI: 1992380885
Provider Name (Legal Business Name): SAMADHI BODYWORK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 SW 216 STREET SUITE 2
MIAMI FL
33170
US

IV. Provider business mailing address

374 SW 16TH TER
HOMESTEAD FL
33030-6627
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-1830
  • Fax:
Mailing address:
  • Phone: 786-488-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: OMAR R MESA
Title or Position: OWNER
Credential: BCBA
Phone: 786-488-1830